National Emergency Medical Services Information System NHTSA ...

National Emergency Medical Services Information System

NEMSIS NHTSA Version 2.2 Data Dictionary (Nebraska Minimum Data Set) WWW.NEMSIS.ORG 2005.12

Introduction The EMS data set is a subset of the information required to describe a complete EMS event. The complete and accurate documentation of clinical care is important to the EMS system, EMS personnel, and the patient. The information collected by the EMS providers is valuable for public health officials to identify the risk factors that result in disease and injuries. Once the risk factors are identified prevention and control strategies are develop to enhance the lives of Nebraskans. Why is it necessary to have a “Nebraska Data Dictionary”? There are over 400 emergency medical services in Nebraska. Various methods and systems for EMS data collection are used by these services. In order to make Nebraska’s EMS patient care data accurate and comparable, including the ability to evaluate and improve the performance of EMS it is crucial to determine a uniform minimum data set. Sufficient detail about each data element must also be included to justify its inclusion in the minimum data set. Nebraska EMS and Trauma Rules and Regulations provide the bases for the Nebraska data elements contained in the Nebraska data dictionary. The entire dictionary will be known as Nebraska’s EMS Data Set. The NEMSIS (National Emergency Medical Services Information System) data element definitions are used to give definition to the data elements contained in the Nebraska EMS Data Set. By using the NEMSIS data definitions Nebraska will be consistent with the Nation. The EMS Program recognizes that the lists that are included in this dictionary are not perfect; however they provide a starting point for EMS data to evolve.

Table of Contents EMS Dataset Number

NEMSIS Data Element

State EMS R/R

State Trauma R/R

Page Number

E1.1

Patient Care Report Number

4.A

124

E2.1

EMS Agency Number

4.A

129

E2.2

Incident #

4.A

130

E2.5

Primary Roll of Unit

20

133

E2.6

Type of Dispatch Delay

21

134

E2.7

Type of Response Delay

21

135

E2.8

Type of Scene Delay

21

136

E2.9

Type of Transport Delay

21

137

E4.1

Crew Member ID

12

154

E4.2

Crew Member Role

155

E4.3

Crew Member Level

156

E5.1

Incident or Onset Date/Time

E5.4

Unit Notified by Dispatch Date/Time

3

3.A & B

158

4.C

161

E5.5

Unit Enroute Date/Time

4

E5.6

Unit Arrived on Scene Date/Time

5

4.D

163

E5.9

Unit Left Scene Date/Time

15

4.E.1

166

E5.10

Patient Arrived at Destination Date/Time

16

4.E.2

167

E5.11

Unit Back in Service Date/Time

17

E6.1

Last Name

1

1.A

172

E6.2

First Name

1

1.A

173

162

168

E6.3

Middle Initial/Name

1

1.A

174

E6.11

Gender

1

1.C

182

E6.12

Race

18

1.D

183

E6.13

Ethnicity

18

E6.14

Age

1

1.E

185

E6.15

Age Units

1

1.E

186

E8.7

Incident Location Type

14

3.F

237

E8.11

Incident Address

2

241

E8.12

Incident City

2

242

E8.13

Incident County

2

243

E8.14

Incident State

2

244

E8.15

Incident Zip Code

2

E9.5

Chief Complaint Narrative

6

251

E9.6

Duration of Chief Complaint

6

252

E9.7

Time Units of Chief Complaint

6

253

E9.8

Secondary Chief Complaint

6

254

E9.9

Duration of Secondary Complaint

6

255

E9.13

Primary Symptom

6

259

E9.14

Other Associated Symptoms

6

260

E10.1

Cause of Injury

184

3.C

3.E

245

265

E10.3

Mechanism of Injury

3.E

268

E10.8

Use of Occupant Safety Equipment

3.G

273

State Trauma R/R

Page Number

3.G

274

EMS Dataset Number

NEMSIS Data Element

State EMS R/R

E10.9

Airbag Deployment

E11.9

Date/Time Resuscitation Discontinued

22

285

E12.1

Barriers to Patient Care

21

289

E12.8

Medication Allergies

8

296

E12.9

Environmental/Food Allergies

8

297

E12.10

Medical/Surgical History

8

298

E12.11

Medical History Obtained From

8

299

E12.12

Immunization History

8

300

E12.13

Immunization Date

8

301

E12.14

Current Medications

8

302

E12.15

Current Medication Dose

8

303

E12.16

Current Medication Dosage Unit

8

304

E12.17

Current Medication Administration Route

8

305

E12.20

Pregnancy

8

308

E14.1

Date/Time Vital Signs Taken

7

312

E14.2

Obtain Prior to this Units EMS Care

13

313

E14.4

SBP (Systolic Blood Pressure)

7

4.F.1

315

E14.5

DBP (Diastolic Blood Pressure)

7

4.F.1

316

E14.6

Method of Blood Pressure

7

E14.7

Pulse Rate

7

E14.10

Pulse Rhythm

7

E14.11

Respiratory Rate

7

E14.12

Respiratory Effort

7

E14.15

GCS Eye

23

4.F.4

326

E14.16

GCS Verbal

23

4.F.4

327

E14.17

GCS Motor

23

4.F.4

328

317 4.F.2

318 321

4.F.3

322 323

E14.18

GCS Qualifier

23

4.F.4

329

E14.19

Total GCS (Glasgow Coma Score)

23

4.F.4

330

E14.27

RTS (Revised Trauma Score)

24

4.F.5

338

E14.28

Pediatric Trauma Score

24

4.F.5

339

E18.1

Date/Time Medication Administered

E18.2

Medication Administered Prior to this Units EMS Care

E18.3

9, 25, 26

380

9, 13

381

Medication Given

9, 25, 26

382

E18.4

Medication Administered Route

9, 25, 26

383

E18.5

Medication Dosage

9, 25, 26

384

E18.6

Medication Dosage Units

9, 25, 26

385

E18.7

Response to Medication

9

386

E18.9

Medication Crew Member ID

9

388

E18.10

Medication Authorization

9

389

E19.1

Date/Time Procedure Performed Successfully

9

392

E19.2

Procedure Performed Prior to this Units EMS Care

13

393

E19.3

Procedure

9

4.F.6

394

EMS Dataset Number

NEMSIS Data Element

State EMS R/R

State Trauma R/R

Page Number

E19.4

Size of Procedure Equipment

9

395

E19.5

Number of Procedure Attempts

9

396

E19.6

Procedure Successful

9

397

E19.7

Procedure Complication

9

398

E19.8

Response to Procedure

9, 10

399

E19.9

Procedure Crew Members ID

9

400

E19.12

Successful IV Site

9

403

E19.13

Tube Confirmation

9

404

E20.1

Destination/Transferred To, Name

11

407

E20.10

Incident/Patient Disposition

20

E20.16

Reasoning for Choosing Destination

19

E20.17

Type of Destination

19

423

E21.1

Event Date/Time

10

425

E21.5

AED, Pacing, or CO2 Mode

10

429

E21.8

Type of Shock

10

432

E21.9

Shock or Pacing Energy

10

433

E21.10

Total Number of Shocks Delivered

10

434

E21.11

Pacing Rate

10

435

416 4.B

422

Section E00

Common EMS Values

Section E00

Common EMS Values

2005 NHTSA Uniform PreHospital Dataset V.2.20

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COMMON NULL VALUES E00 Data Format [combo] single-choice Definition These values are to be used in each of the Demographic and EMS Data Elements described in this document which have been defined to accept the E00 Null Values. Please include these variables in the implementation of the NHTSA Version 2 Dataset.

Field Values -25 Not Applicable -15 Not Reporting -5 Not Available

-20 Not Recorded -10 Not Known

Additional Information ● For any collection of data to be of value and reliably represent what was intended, a strong commitment must be made to ensure the correct documentation of incomplete data . The described data integrity method must be followed with the NHTSA dataset For data elements being electronically stored in a database or moved from one database to another using XML, the indicated values should be applied when a data element is empty or contains a null value. ● Not Applicable: (Code -25) = At the time of an EMS patient care report documentation, information requested was “Not Applicable” to the EMS or patient event. This indicates that it is unnecessary to document mechanism or injury related information on a patient who was not traumatized ● Not Available: (Code -5) = At the time of an EMS patient care report documentation, information was “Not Available” to EMS personnel. This documents that needed information did exist but the EMS personnel was unsuccessful in their attempt to obtain it ● Not Known: (Code -10) = At the time of an EMS patient care report documentation, information was “Not Known” to patient, family, and EMS personnel. This documents that there was an attempt to obtain information but it was unknown by all parties involved ● Not Recorded: (Code -20) = If an EMS documentation or information system has an empty field or nothing is recorded in any data element of the NHTSA dataset, code “-20” should be inserted into the database and/or XML for that data element indicating that the EMS Patient Care Report did not have a value for that specific data element when the EMS event or patient encounter was documented ● Not Reporting: (Code -15) = If an EMS documentation or information system is not using any of the "National" data elements of the NHTSA dataset, code “-15” should be inserted into the database and/or XML for that data element.

Section E00

Common EMS Values


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Section E01

Record Information

Section E01

Record Information


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PATIENT CARE REPORT NUMBER

National Element

Data Format [text]

E01_01

Definition The unique number automatically assigned by the EMS agency for each patient care report (PCR). This is a unique number to the EMS agency for all of time. XSD Data Type xs:string Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) PatientCareReportNumber Accepts Null No Minimum Constraint 3 Maximum Constraint 32

Field Values A unique value; no variable list is possible.

Additional Information ● Not Nullable. A unique value must be provided to create a unique record ID within a database

Uses ● A component of the EMS Medical Record: Patient Care Report ● Agency number (E02_01), agency state (D01_03),unit call sign (E02_12), patient number (E01_01) and date (E05_04) combine to create a unique identifier

Data Collector ● EMS agency or may be electronically provided through the 911 or dispatch center

Other Associated Elements E01_01 Patient Care Report Number

References in NHTSA Version 1 Desirable Element 23

Patient Care Record Number

References to Other Databases

● NFIRS 5.0 EMS Module; Title: Patient Number; Unique Number

State Regulations ● Nebraska Trauma Regulation 4.A

Section E01

Record Information


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Section E02

Unit/ Agency Information

Section E02



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EMS AGENCY NUMBER

National Element

Data Format [text]

E02_01

Definition The state-assigned provider number of the responding agency XSD Data Type xs:string Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) EMSAgencyNumber Accepts Null No Minimum Constraint 3 Maximum Constraint 15

Field Values A unique value; no variable list is possible.

Additional Information ● Not Nullable. A unique value must be provided to create a unique record ID within a database ● Same as EMS Agency Number (D01_01)

Uses ● A component of the EMS Medical Record: Patient Care Report ● Agency number (E02_01), agency state (D01_03),unit call sign (E02_12), patient number (E01_01) and date (E05_04) combine to create a unique identifier ● Allows data to be sorted by the EMS Agency ● Important for grouping and comparing EMS Agencies in Benchmarking and Quality Management ● When linked to D01_02 provides the Agency name on the EMS Medical Record: Patient Care Report

Data Collector ● Typically generated by the State EMS Regulatory Office. Collected by the EMS agency or auto-generated by the EMS agency specific software.



● NFIRS 5.0 EMS Module;Title: FDID; State assigned Fire Department ID number


Section E02



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INCIDENT NUMBER E02_02 Data Format [text] Definition The incident number assigned by the 911 Dispatch System XSD Data Type xs:string Multiple Entry Configuration No Required in XSD No

XSD Domain (Simple Type) IncidentNumber Accepts Null Yes Minimum Constraint 2 Maximum Constraint 15

Field Values -25 Not Applicable -5 Not Available

-10 Not Known ● Relevant Value for Data Element & Patient Care

Uses ● Component of the EMS Agency 911 or Dispatch information which serves as a link to identify and report other Dispatch information

Data Collector ● 911 or Dispatch Center and electronically or verbally transmitted to the EMS agency

Other Associated Elements E00

Common Null Values

E01_01 Patient Care Report Number

References in NHTSA Version 1 Essential Element 21

Incident Number


● NFIRS 5.0 EMS Module; Title: Incident Number; Unique number for each Incident


Section E02



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PRIMARY ROLE OF THE UNIT

National Element

Data Format [combo] single-choice

E02_05

Definition The primary role of the EMS service which was requested for this specific EMS incident. XSD Data Type xs:integer Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) PrimaryRollOfTheUnit Accepts Null No

Field Values 60 Non-Transport 70 Supervisor

65 Rescue 75 Transport

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted by the role of the responder ● Provides descriptive data on EMS call volume and service provided



Section E02



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TYPE OF DISPATCH DELAY

National Element

Data Format [combo] multiple-choice

E02_06

Definition The dispatch delays, if any, associated with the dispatch of the EMS unit to the patient encounter XSD Data Type xs:integer Multiple Entry Configuration Yes Required in XSD Yes

XSD Domain (Simple Type) TypeOfDispatchDelay Accepts Null Yes

Field Values -25 -10 80 90 100 110 120

Not Applicable Not Known Caller (Uncooperative) Language Barrier No Units Available Other Technical Failure (Computer, Phone etc.)

-15 -5 85 95 105 115

Not Reporting Not Available High Call Volume Location (Inability to Obtain) None Scene Safety (Not Secure for EMS)

Uses ● Allows data to describe the status of Dispatch issues



Common Null Values



Factors Affecting EMS Delivery of Care

State Regulations ● Nebraska EMS Regulation 21

Section E02



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TYPE OF RESPONSE DELAY

National Element


E02_07

Definition The response delays, if any, of the unit associated with the patient encounter XSD Data Type xs:integer Multiple Entry Configuration Yes Required in XSD Yes

XSD Domain (Simple Type) TypeOfResponseDelay Accepts Null Yes

Field Values -25 -10 125 135 145 155 165 175 185

Not Applicable Not Known Crowd Distance HazMat Other Staff Delay Vehicle Crash Weather

-15 -5 130 140 150 160 170 180

Not Reporting Not Available Directions Diversion None Safety Traffic Vehicle Failure

Uses ● Allows data describe Vehicle Failures and Vehicle Crashes ● Allows data to describe the status of Response issues

Data Collector ● EMS personnel


Common Null Values





Section E02



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TYPE OF SCENE DELAY

National Element


E02_08

Definition The scene delays, if any, of the unit associated with the patient encounter XSD Data Type xs:integer Multiple Entry Configuration Yes Required in XSD Yes

XSD Domain (Simple Type) TypeOfSceneDelay Accepts Null Yes

Field Values -25 -10 190 200 210 220 230 240 250 260

Not Applicable Not Known Crowd Distance Extrication >20 min. Language Barrier Other Staff Delay Vehicle Crash Weather

-15 -5 195 205 215 225 235 245 255

Not Reporting Not Available Directions Diversion HazMat None Safety Traffic Vehicle Failure

Uses ● Allows data describe Vehicle Failures and Vehicle Crashes ● Allows data to describe the status of Scene issues



Common Null Values





Section E02



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TYPE OF TRANSPORT DELAY

National Element


E02_09

Definition The transport delays, if any, of the unit associated with the patient encounter XSD Data Type xs:integer Multiple Entry Configuration Yes Required in XSD Yes

XSD Domain (Simple Type) TypeOfTransportDelay Accepts Null Yes

Field Values -25 -10 265 275 285 295 305 315 325

Not Applicable Not Known Crowd Distance HazMat Other Staff Delay Vehicle Crash Weather

-15 -5 270 280 290 300 310 320

Not Reporting Not Available Directions Diversion None Safety Traffic Vehicle Failure

Uses ● Allows data describe Vehicle Failures and Vehicle Crashes ● Allows data to describe the status of Transport issues



Common Null Values





Section E02



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Section E04

Unit/ Personnel Information

Section E04



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CREW MEMBER ID E04_01 Data Format [text] Definition The State Certification/Licensure ID number assigned to the crew member XSD Data Type xs:string XSD Domain (Simple Type) CrewMemberID Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No Minimum Constraint 2 Maximum Constraint 15 XSD Structure: E04_01, E04_02, E04_03 are all members of the E04 Unit Personnel Information structure



Additional Information ● A multiple entry configuration to allow all crew members to be entered ● Linked to State/Licensure ID Number (D07_02) ● List box created from the State/ Licensure ID Number (D07_02) which could display the Personnel’s Names as associated with D08_01, D08_02, and D08_03 for easy data entry

Uses ● A component of the EMS Medical Record: Patient Care Report ● Associates an EMS event with specific EMS personnel ● Useful for reporting EMS personnel statistics related to EMS events and evaluation of EMS personnel performance


Other Associated Elements E00 Common Null Values E04_02 Crew Member Role

E01_01 Patient Care Report Number E04_03 Crew Member Level

References in NHTSA Version 1 Essential Element 26 Essential Element 27 Desirable Element 28

Crew Member One Number Crew Member Two Number Crew Member Three Number


Section E04



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CREW MEMBER ROLE E04_02 Data Format [combo] single-choice Definition The role of the crew member during transport of this call. ● Driver is defined as the driver during the time of patient transport or during the response if there was not transport required. ● Primary Patient Care Giver is defined as the individual responsible for the patient care during the transport of the patient, or if no transport, the individual responsible for the assessment and treatment of the patient on scene. ● Secondary Patient Care Giver is defined as the individual assisting the Primary Patient Care Giver. ● Third Patient Care Giver is defined as the individual assisting in the Primary and Secondary Patient Care Givers. XSD Data Type xs:integer XSD Domain (Simple Type) CrewMemberRole Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: E04_01, E04_02, E04_03 are all members of the E04 Unit Personnel Information structure

Field Values -25 -5 585 595

Not Applicable Not Available Primary Patient Caregiver Third Patient Caregiver

-10 580 590 600

Not Known Driver Secondary Patient Caregiver Other



Other Associated Elements E00 Common Null Values E04_01 Crew Member ID

Section E04

E01_01 Patient Care Report Number E04_03 Crew Member Level



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CREW MEMBER LEVEL E04_03 Data Format [combo] single-choice Definition The functioning level of the crew member during this EMS patient encounter. XSD Data Type xs:integer XSD Domain (Simple Type) CrewMemberLevel Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: E04_01, E04_02, E04_03 are all members of the E04 Unit Personnel Information structure

Field Values -25 -5 640 6090 6110 6112

Not Applicable Not Available Other Healthcare Professional EMT-Basic EMT-Paramedic Physician

-10 635 645 6100 6111 6120

Not Known Student Other Non-Healthcare Professional EMT-Intermediate Nurse First Responder

Additional Information ● Could be auto-filled using Crew Member ID (E04_01) and connecting to State/ Licensure ID Number (D07_02) to obtain Personnel’s Highest Level of Certification/ Licensure for Agency (D07_05) ● This list can be edited by each state to account for additional certification/ licensure levels as defined in (D04_01) and Personnel’s Highest Level of Certification/ Licensure for the Agency (D07_05)



Other Associated Elements E00 Common Null Values E04_01 Crew Member ID

E01_01 Patient Care Report Number E04_02 Crew Member Role


Crew Member One Type Crew Member Two Type Crew Member Three Type


● NFIRS 5.0 EMS Module, Title: Highest Level of Provider on Scene by Fire Department, Pick-List: First Responder = 1, EMT-B (Basic) = 2, EMT-I (Intermediate) = 3, EMT-P (Paramedic) = 4, Other Health Care Provider, Include Doctors, Nurses = O, No Care Provided = N ● NFIRS 5.0 EMS Module; Title: Initial Level of FD Provider; Pick-List: First Responder = 1, EMT-B (Basic) = 2, EMT-I (Intermediate) = 3, EMT-P (Paramedic) = 4, Other Health Care Provider, Includes Doctors, Nurses, etc. = O, No Training = N

Section E04



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Section E05

Times

Section E05

Times


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INCIDENT OR ONSET DATE/TIME E05_01 Data Format [date/time] Definition The date/time the injury occurred, or the date/time the symptoms or problem started XSD Data Type xs:dateTime Multiple Entry Configuration No Required in XSD No

XSD Domain (Simple Type) DateTime Accepts Null Yes, but null value is blank or empty Minimum Constraint 1990 Maximum Constraint 2030

Field Values ● Relevant Value for Data Element & Patient Care

Additional Information ● If the date/time is electronically stored within a database or transmitted via XML as a “tick”, the referenced variables may also be used

Uses ● Important to identify when the clinical event started to better analyze EMS resource utilization and outcomes ● Provides descriptive information on the use of the EMS agency



References in NHTSA Version 1 Desirable Element 06 Desirable Element 07

Onset Date Onset Time


● NFIRS 5.0 Basic Module 1; Title: Incident Date; Date Field defined as YYYYMMDD or blank

State Regulations ● Nebraska Trauma Regulation 3.A & B

Section E05

Times


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UNIT NOTIFIED BY DISPATCH DATE/TIME

National Element

Data Format [date/time]

E05_04

Definition The date the responding unit was notified by dispatch XSD Data Type xs:dateTime Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) DateTime Accepts Null No Minimum Constraint 1990 Maximum Constraint 2030


Additional Information ● If the date/time is electronically stored within a database or transmitted via XML as a “tick”, the referenced variables may also be used ● Not Nullable. A unique value must be provided to create a unique record ID within a database

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on EMS agency time intervals ● Allows data to describe EMS agency time intervals



References in NHTSA Version 1 Essential Element 11 Essential Element 12

Date Unit Notified Time Unit Notified

State Regulations ● Nebraska EMS Regulation 3 ● Nebraska Trauma Regulation 4.C

Section E05

Times


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UNIT EN ROUTE DATE/TIME

National Element


E05_05

Definition The date/time the unit responded; that is, the time the vehicle started moving XSD Data Type xs:dateTime Multiple Entry Configuration No Required in XSD Yes








Time Unit Responding


Section E05

Times


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UNIT ARRIVED ON SCENE DATE/TIME

National Element


E05_06

Definition The date/time the responding unit arrived on the scene; that is, the time the vehicle stopped moving XSD Data Type xs:dateTime Multiple Entry Configuration No Required in XSD Yes








Time of Arrival at Scene

State Regulations ● Nebraska EMS Regulation 5 ● Nebraska Trauma Regulation 4.D

Section E05

Times


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UNIT LEFT SCENE DATE/TIME

National Element


E05_09

Definition The date/time the responding unit left the scene (started moving) XSD Data Type xs:dateTime Multiple Entry Configuration No Required in XSD Yes








Time Unit Left Scene

State Regulations ● Nebraska EMS Regulation 15 ● Nebraska Trauma Regulation 4.E.1

Section E05

Times


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PATIENT ARRIVED AT DESTINATION DATE/TIME

National Element


E05_10

Definition The date/time the responding unit arrived with the patient at the destination or transfer point XSD Data Type xs:dateTime Multiple Entry Configuration No Required in XSD Yes








Time of Arrival at Destination

State Regulations ● Nebraska EMS Regulation 16 ● Nebraska Trauma Regulation 4.E.2

Section E05

Times


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UNIT BACK IN SERVICE DATE/TIME

National Element


E05_11

Definition The date/time the unit back was back in service and available for response (finished with call, but not necessarily back in home location) XSD Data Type xs:dateTime Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) DateTime Accepts Null No Minimum Constraint 1990 Maximum Constraint 2030







Time Back in Service


Section E05

Times


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Section

E06

Patient

Section E06

Patient


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LAST NAME E06_01 Data Format [text] Definition The patient's last (family) name XSD Data Type xs:string XSD Domain (Simple Type) LastName Multiple Entry Configuration No Accepts Null Yes Required in XSD No Minimum Constraint 2 Maximum Constraint 20 XSD Structure: E06_01, E06_02, and E06_03 are all members of the E06_01_0 Patient Name Structure



Additional Information ● Local Policy should dictate how Last Name and First Name should be created if Unknown

Uses ● Allows a patient’s information to be stored and retrieved by Name ● Key component of an EMS Medical Record ● Provides contact information for multiple purposes including follow-up, billing, bioterrorism syndromic surveillance, etc

Data Collector ● EMS personnel or electronically through linkage with a pre-existing Patient Care Report or hospital database

Other Associated Elements E00 Common Null Values E06_02 First Name

E01_01 Patient Care Report Number E06_03 Middle Initial/Name


Patient Name

State Regulations ● Nebraska EMS Regulation 1 ● Nebraska Trauma Regulation 1.A

Section E06

Patient


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FIRST NAME E06_02 Data Format [text] Definition The patient's first (given) name XSD Data Type xs:string XSD Domain (Simple Type) FirstName Multiple Entry Configuration No Accepts Null Yes Required in XSD No Minimum Constraint 1 Maximum Constraint 20 XSD Structure: E06_01, E06_02, and E06_03 are all members of the E06_01_0 Patient Name Structure






Other Associated Elements E00 Common Null Values E06_01 Last Name

E01_01 Patient Care Report Number E06_03 Middle Initial/Name


Patient Name


Section E06

Patient


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MIDDLE INITIAL/NAME E06_03 Data Format [text] Definition The patient's middle name, if any XSD Data Type xs:string XSD Domain (Simple Type) MiddleInitialName Multiple Entry Configuration No Accepts Null Yes Required in XSD No Minimum Constraint 1 Maximum Constraint 20 XSD Structure: E06_01, E06_02, and E06_03 are all members of the E06_01_0 Patient Name Structure







E01_01 Patient Care Report Number E06_02 First Name


Patient Name


Section E06

Patient


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GENDER

National Element


E06_11

Definition The patient's gender XSD Data Type xs:integer Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) Gender Accepts Null

Yes

Field Values -25 Not Applicable -10 Not Known 650 Male

-15 Not Reporting -5 Not Available 655 Female

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on gender ● Allows data to describe the gender of the EMS patient population





Gender


● NFIRS 5.0 EMS Module; Title: Gender; Pick-List: Male = 1, Female = 2


Section E06

Patient


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RACE

National Element


E06_12

Definition The patient's race as defined by the OMB (US Office of Management and Budget) XSD Data Type xs:integer Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) Race Accepts Null

Yes

Field Values -25 -10 660 670 680

Not Applicable Not Known American Indian or Alaska Native Black or African American White

-15 -5 665 675 685

Not Reporting Not Available Asian Native Hawaiian or Other Pacific Islander Other Race

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on race as required from a state and federal government reporting perspective ● Allows data to describe the race of the EMS patient population





Race/Ethnicity


● NFIRS 5.0 EMS Module; Title: Race; Pick-List: White = 1, Black = 2, American Indian, Eskimo, Aleut = 3, Asian = 4, Other, Multi-racial = 0, Race Undetermined = U

State Regulations ● Nebraska EMS Regulation 18 ● Nebraska Trauma Regulation 1.D

Section E06

Patient


Page 183 of 463

ETHNICITY

National Element


E06_13

Definition The patient's ethnicity as defined by the OMB (US Office of Management and Budget) XSD Data Type xs:integer Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) Ethnicity Accepts Null

Yes

Field Values -25 Not Applicable -10 Not Known 690 Hispanic or Latino

-15 Not Reporting -5 Not Available 695 Not Hispanic or Latino

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on ethnicity as required from a state and federal government reporting perspective ● Allows data to describe the ethnicity of the EMS patient population





Race/Ethnicity


● NFIRS 5.0 EMS Module; Title: Ethnicity; Check-Box: Hispanic = Yes or No


Section E06

Patient


Page 184 of 463

AGE

National Element

Data Format [number]

E06_14

Definition The patient's age (either calculated from date of birth or best approximation) XSD Data Type xs:integer XSD Domain (Simple Type) Age Multiple Entry Configuration No Accepts Null Yes, but null value is blank or empty Required in XSD Yes Minimum Constraint 1 Maximum Constraint 120 XSD Structure: E06_14 and E06_15 are members of the E06_14_0 Patient's Age Structure


Additional Information ● Could be calculated from Date of Birth (E06_16)

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on age ● Allows data to describe the age of the EMS patient population


Other Associated Elements E01_01 Patient Care Report Number E06_15 Age Units

E06_01 Last Name


Age


● NFIRS 5.0 EMS Module; Title: Age; The age of the patient or best approximation. If less than one year then enter the number of months.

State Regulations ● Nebraska EMS Regulation 1 ● Nebraska Trauma Regulation 1.E

Section E06

Patient


Page 185 of 463

AGE UNITS

National Element


E06_15

Definition The units which the age is documented in (Hours, Days, Months, Years) XSD Data Type xs:integer XSD Domain (Simple Type) AgeUnits Multiple Entry Configuration No Accepts Null Yes Required in XSD Yes XSD Structure: E06_14 and E06_15 are members of the E06_14_0 Patient's Age Structure

Field Values -25 -10 700 710

Not Applicable Not Known Hours Months

-15 -5 705 715

Not Reporting Not Available Days Years

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on age ● Allows data to describe the age of the EMS patient population


Other Associated Elements E00 Common Null Values E06_14 Age



Age

State Regulations ● Nebraska EMS Regulation 1 ● Nebraska Trauma Regulation 1.E

Section E06

Patient


Page 186 of 463

Section E08

Scene

Section E08

Scene


Page 230 of 463

INCIDENT LOCATION TYPE

National Element


E08_07

Definition The kind of location where the incident happened XSD Data Type xs:integer Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) IncidentLocationType Accepts Null Yes

Field Values -25 -10 1135 1145 1155 1165 1175 1185

Not Applicable Not Known Home/Residence Mine or Quarry Place of Recreation or Sport Public Building (schools, gov. offices) Health Care Facility (clinic, hospital, nursing home) Lake, River, Ocean

-15 -5 1140 1150 1160 1170 1180 1190

Not Reporting Not Available Farm Industrial Place and Premises Street or Highway Trade or service (business, bars, restaurants, etc) Residential Institution (Nursing Home, jail/prison) Other Location

Additional Information ● Based on ICD-9

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on the Incident Location and Type ● Allows data to describe the Incident Location and the distribution of EMS events



Common Null Values



Location Type


● UTSTEIN Title: Location of Arrest: Out of Hospital; Same as NHTSA E-Codes

State Regulations ● Nebraska EMS Regulation 14 ● Nebraska Trauma Regulation 3.F

Section E08

Scene


Page 237 of 463

INCIDENT ADDRESS E08_11 Data Format [text] Definition The street address (or best approximation) where the patient was found, or, if no patient, the address to which the unit responded. XSD Data Type xs:string XSD Domain (Simple Type) StreetAddress Multiple Entry Configuration No Accepts Null Yes Required in XSD No Minimum Constraint 2 Maximum Constraint 30 XSD Structure: E08_11, E08_12, E08_14, E08_15 are all members of E08_11_0 Incident Address Structure



Uses ● A component of the EMS Medical Record: Patient Care Report ● Important for grouping or comparing data by Scene location which also allows data to be sorted by geographic response areas in many agencies ● Provides information on overall response patterns and times for agency configuration and evaluation


Other Associated Elements E00 Common Null Values E08_07 Incident Location Type E08_14 Incident State

E01_01 Patient Care Report Number E08_12 Incident City E08_15 Incident ZIP Code


Incident Address


Section E08

Scene


Page 241 of 463

INCIDENT CITY E08_12 Data Format [combo] single-choice Definition The city or township (if applicable) where the patient was found or to which the unit responded (or best approximation) XSD Data Type xs:string XSD Domain (Simple Type) City Multiple Entry Configuration No Accepts Null Yes Required in XSD No Minimum Constraint 2 Maximum Constraint 30 XSD Structure: E08_11, E08_12, E08_14, E08_15 are all members of E08_11_0 Incident Address Structure



Additional Information ● 5 digit FIPS Code ● Could be filled in from Incident Zip Code entry (E08_15)



Other Associated Elements E00 Common Null Values E08_07 Incident Location Type E08_14 Incident State

E01_01 Patient Care Report Number E08_11 Incident Address E08_15 Incident ZIP Code


Incident City


Section E08

Scene


Page 242 of 463

INCIDENT COUNTY E08_13 Data Format [combo] single-choice Definition The county or parish where the patient was found or to which the unit responded (or best approximation) XSD Data Type xs:string Multiple Entry Configuration No Required in XSD No

XSD Domain (Simple Type) County Accepts Null Yes Minimum Constraint 2 Maximum Constraint 5



Additional Information ● Could be filled in from Incident Zip Code entry (E08_15) ● Stored as a 5 digit FIPS code (combining the state and county code) to take into account agencies may serve more than one state and counties are often named the same from state to state ● Stored as a FIPS code



Other Associated Elements E00 Common Null Values E08_07 Incident Location Type



Incident County


Section E08

Scene


Page 243 of 463

INCIDENT STATE E08_14 Data Format [combo] single-choice Definition The state, territory, or province where the patient was found or to which the unit responded (or best approximation) XSD Data Type xs:string XSD Domain (Simple Type) State Multiple Entry Configuration No Accepts Null Yes Required in XSD No Minimum Constraint 2 Maximum Constraint 3 XSD Structure: E08_11, E08_12, E08_14, E08_15 are all members of E08_11_0 Incident Address Structure



Additional Information ● 2 digit FIPS code ● Could be filled in from Incident Zip Code entry (E08_15)



Other Associated Elements E00 Common Null Values E08_07 Incident Location Type E08_12 Incident City

E01_01 Patient Care Report Number E08_11 Incident Address E08_15 Incident ZIP Code


Incident State


● NFIRS 5.0 Basic Module 1; Title: State; 2 digit FIPS; Text Field Size = 2


Section E08

Scene


Page 244 of 463

INCIDENT ZIP CODE

National Element

Data Format [text]

E08_15

Definition The ZIP code of the incident location XSD Data Type xs:string XSD Domain (Simple Type) Zip Multiple Entry Configuration No Accepts Null Yes Required in XSD Yes Minimum Constraint 2 Maximum Constraint 10 XSD Structure: E08_11, E08_12, E08_14, E08_15 are all members of E08_11_0 Incident Address Structure

Field Values -25 Not Applicable -10 Not Known ● Relevant Value for Data Element & Patient Care

-15 Not Reporting -5 Not Available

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on the geographic location of the EMS Incident ● Allows data to describe geographic location of the EMS Incident


Other Associated Elements E00 Common Null Values E08_07 Incident Location Type E08_12 Incident City

E01_01 Patient Care Report Number E08_11 Incident Address E08_14 Incident State


Section E08

Scene


Page 245 of 463

Section E09

Situation

Section E09

Situation


Page 246 of 463

CHIEF COMPLAINT E09_05 Data Format [text] Definition The statement of the problem by the patient or the history provider in one or two words XSD Data Type xs:string Multiple Entry Configuration No Required in XSD No

XSD Domain (Simple Type) ChiefComplaintNarrative Accepts Null Yes Minimum Constraint 2 Maximum Constraint 50



Uses ● Allows data to be sorted based on the use of EMS Chief Complaint ● Allows data to describe EMS services delivered based on the EMS patient's chief complaint ● Important for an EMS Medical Record



Common Null Values



Chief Complaint


Section E09

Situation


Page 251 of 463

DURATION OF CHIEF COMPLAINT E09_06 Data Format [number] Definition The time duration of the chief complaint XSD Data Type xs:integer XSD Domain (Simple Type) DurationOfChiefComplaint Multiple Entry Configuration No Accepts Null No Required in XSD No Minimum Constraint 1 Maximum Constraint 360 XSD Structure: E09_06 and E09_07 are members of E09_06_0 Duration of Chief Complaint Structure


Uses ● Important for an EMS Medical Record ● Important to evaluate clinical conditions which are time dependant such as MI or Stroke to determine appropriate EMS care


Other Associated Elements E01_01 Patient Care Report Number E09_07 Time Units of Duration of Chief Complaint

E09_05 Chief Complaint


Section E09

Situation


Page 252 of 463

TIME UNITS OF DURATION OF CHIEF COMPLAINT E09_07 Data Format [combo] single-choice Definition The time units of the duration of the patient's chief complaint XSD Data Type xs:integer XSD Domain (Simple Type) TimeUnitsOfChiefComplaint Multiple Entry Configuration No Accepts Null No Required in XSD No XSD Structure: E09_06 and E09_07 are members of E09_06_0 Duration of Chief Complaint Structure

Field Values 1235 1245 1255 1265

Seconds Hours Weeks Years

1240 Minutes 1250 Days 1260 Months ● Relevant Value for Data Element & Patient Care



Other Associated Elements E01_01 Patient Care Report Number E09_06 Duration of Chief Complaint

E09_05 Chief Complaint


Section E09

Situation


Page 253 of 463

SECONDARY COMPLAINT NARRATIVE E09_08 Data Format [text] Definition The narrative of the patient's secondary complaint XSD Data Type xs:string Multiple Entry Configuration No Required in XSD No

XSD Domain (Simple Type) SecondaryComplaintNarrative Accepts Null Yes Minimum Constraint 2 Maximum Constraint 50



Uses ● Allows data to be sorted based on the use of EMS Chief Complaint ● Allows data to describe EMS services delivered based on the patient's chief complaint ● Important for an EMS Medical Record



Common Null Values



Chief Complaint


Section E09

Situation


Page 254 of 463

DURATION OF SECONDARY COMPLAINT E09_09 Data Format [number] Definition The duration of the secondary complaint XSD Data Type xs:integer XSD Domain (Simple Type) DurationOfSecondaryComplaint Multiple Entry Configuration No Accepts Null No Required in XSD No Minimum Constraint 1 Maximum Constraint 360 XSD Structure: E09_09 and E09_10 are members of E09_09_0 Duration of Secondary Complaint Structure




Other Associated Elements E01_01 Patient Care Report Number E09_08 Secondary Complaint Narrative E09_10 Time Units of Duration of Secondary Complaint


Section E09

Situation


Page 255 of 463

PRIMARY SYMPTOM

National Element


E09_13

Definition The primary sign and symptom present in the patient or observed by EMS personnel XSD Data Type xs:integer Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) PrimarySymptom Accepts Null Yes

Field Values -25 -10 1405 1415 1425 1435 1445 1455 1465 1475 1485 1495 1505

Not Applicable Not Known Bleeding Change in responsiveness Death Diarrhea Fever Mass/Lesion Nausea/Vomiting Pain Rash/Itching Transport Only Wound

-15 -5 1410 1420 1430 1440 1450 1460 1470 1480 1490 1500

Not Reporting Not Available Breathing Problem Choking Device/Equipment Problem Drainage/Discharge Malaise Mental/Psych None Palpitations Swelling Weakness

Additional Information ● Possible Injury (E09_04), Chief Complaint Anatomic Location (E09_11), Chief Complaint Organ System (E09_12), and Primary Symptom (E09_13) are required to calculate the Reason for Encounter

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on the patient's primary symptom ● Allows data to describe the patient's primary symptom ● Allows for the calculation of the "EMS Reason for Encounter" used to further describe the EMS patient population



Common Null Values



Signs and Symptoms Present


Section E09

Situation


Page 259 of 463

OTHER ASSOCIATED SYMPTOMS

National Element


E09_14

Definition Other symptoms identified by the patient or observed by EMS personnel XSD Data Type xs:integer Multiple Entry Configuration Yes Required in XSD Yes

XSD Domain (Simple Type) OtherAssociatedSymptoms Accepts Null Yes

Field Values -25 -10 1405 1415 1425 1435 1445 1455 1465 1475 1485 1495 1505

Not Applicable Not Known Bleeding Change in responsiveness Death Diarrhea Fever Mass/Lesion Nausea/Vomiting Pain Rash/Itching Transport Only Wound

-15 -5 1410 1420 1430 1440 1450 1460 1470 1480 1490 1500

Not Reporting Not Available Breathing Problem Choking Device/Equipment Problem Drainage/Discharge Malaise Mental/Psych None Palpitations Swelling Weakness

Additional Information ● This data element is used for Bioterrorism Syndromic Surveillance

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on the patient's primary symptom ● Allows data to describe the patient's associated symptoms ● Allows for potential bio-terrorism surveillance based on the symptomatic presentation of the EMS Patient combined with other data points



Common Null Values



Signs and Symptoms Present


Section E09

Situation


Page 260 of 463

Section E10

Situation/ Trauma

Section E10

Situation/ Trauma


Page 264 of 463

CAUSE OF INJURY

National Element


E10_01

Definition The category of the reported/suspected external cause of the injury XSD Data Type xs:integer Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) CauseOfInjury Accepts Null Yes

Field Values -25 -10 9500 9510 9520 9530 9540 9550 9560 9570 9580 9590 9600 9610 9620 9630 9640 9650

Not Applicable Not Known Aircraft related accident (E84X.0) Bites (E906.0) Child battering (E967.0) Drug poisoning (E85X.0) Excessive Cold (E901.0) Falls (E88X.0) Firearm assault (E965.0) Firearm self inflicted (E955.0) Machinery accidents (E919.0) Motor Vehicle non-traffic accident (E82X.0) Motorcycle Accident (E81X.1) Pedestrian traffic accident (E814.0) Rape (E960.1) Stabbing/Cutting Accidental (E986.0) Struck by Blunt/Thrown Object (E968.2) Water Transport accident (E83X.0)

-15 -5 9505 9515 9525 9535 9545 9555 9565 9575 9585 9595 9605 9615 9625 9635 9645

Not Reporting Not Available Bicycle Accident (E826.0) Chemical poisoning (E86X.0) Drowning (E910.0) Electrocution (non-lightning) (E925.0) Excessive Heat (E900.0) Fire and Flames (E89X.0) Firearm injury (accidental) (E985.0) Lightning (E907.0) Mechanical Suffocation (E913.0) Motor Vehicle traffic accident (E81X.0) Non-Motorized Vehicle Accident (E848.0) Radiation exposure (E926.0) Smoke Inhalation (E89X.2) Stabbing/Cutting Assault (E966.0) Venomous stings (plants, animals) (E905.0)

Additional Information ● Complete only if Possible Injury (E09_04) is “Yes” ● ICD-9 Codes were retained over ICD-10 due to CMS’s continued use of ICD-9 in the EMS Condition Codes

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on the traumatic cause of injury ● Allows data to describe the cause of a traumatic event

Data Collector ● EMS personnel if Possible Injury (E09_04) is answered Yes


Common Null Values



Cause of Injury


● NFIRS 5.0 EMS Module; Title: Cause of Illness/Injury; The immediate cause or condition responsible for the injury or illness; Pick-List: Chemical Exposure = 10, Drug Poisoning = 11, Fall = 12, Aircraft Related = 13, Bite, Includes Animal Bites = 14, Bicycle Accident = 15, Building Collapse/Construction Accident = 16, Downing = 17, Electrical Shock = 18, Cold = 19, Heat = 20, E explosives - 21, Fire and Flames - 22. Firearm = 23, Fireworks = 25, Lightning = 26, Machinery = 27, Mechanical Suffocation = 28, Motor Vehicle Accident = 29, Motor Vehicle Accident, Pedestrian = 30, Non-Traffic Vehicle (off road) Accident = 31, Physical Assault/Abuse = 32, Scalds/Other Thermal = 33, Smoke Inhalation = 34, Stabbing Assault = 35, Venomous

Section E10

Situation/ Trauma


Page 265 of 463

Sting = 36, Water Transport = 37, Other Cause of Injury/Illness = 00, Unknown Cause of Injury/Illness = UU

State Regulations ● Nebraska Trauma Regulation 3.E

Section E10 2005 NHTSA Uniform PreHospital Dataset V.2.20

Situation/ Trauma

Page 266 of 463

MECHANISM OF INJURY E10_03 Data Format [combo] multiple-choice Definition The mechanism of the event which caused the injury. XSD Data Type xs:integer Multiple Entry Configuration Yes Required in XSD No

XSD Domain (Simple Type) MechanismOfInjury Accepts Null Yes

Field Values -25 -5 2040 2050

Not Applicable Not Available Burn Penetrating

-10 Not Known 2035 Blunt 2045 Other

Additional Information ● Complete only if Possible Injury (E09_04) is “Yes”

Uses ● A component of the EMS Medical Record: Patient Care Report ● Important component of an EMS Medical Record to identify issues of clinical care and agency performance and delivery ● Used to better define injury cause and describe injury patterns within and EMS community

Data Collector ● EMS personnel if Possible Injury (E09_04) is answered Yes


Common Null Values


State Regulations ● Nebraska Trauma Regulation 3.E

Section E10

Situation/ Trauma


Page 268 of 463

USE OF OCCUPANT SAFETY EQUIPMENT E10_08 Data Format [combo] multiple-choice Definition Safety equipment in use by the patient at the time of the injury XSD Data Type xs:integer Multiple Entry Configuration Yes Required in XSD No

XSD Domain (Simple Type) UseOfOccupantSafetyEquipment Accepts Null Yes

Field Values -25 -5 2175 2185 2190 2200 2210

Not Applicable Not Available Eye Protection Lap Belt Other Protective Clothing Shoulder Belt

-10 2170 2180 2187 2195 2205

Not Known Child Restraint Helmet Worn None Personal Floatation Device Protective Non-Clothing Gear



Data Collector ● EMS personnel if Possible Injury (E09_04) is answered Yes and there is a vehicle involved


Common Null Values



Safety Equipment


● NFIRS 5.0 EMS Module; Title: Safety Equipment; Multiple Select Pick-List: Safety, Seat Belts =1, Child Safety Seat = 2, Airbag = 3, Helmet = 4, Protective Clothing = 5, Flotation Device = 6, None or No Safety Equipment = N, Other Safety Equipment Used = O, Undetermined Safety Equipment = U

State Regulations ● Nebraska Trauma Regulation 3.G

Section E10

Situation/ Trauma


Page 273 of 463

AIRBAG DEPLOYMENT E10_09 Data Format [combo] multiple-choice Definition Indication of Airbag deployment during the motor vehicle crash. XSD Data Type xs:integer Multiple Entry Configuration Yes Required in XSD No

XSD Domain (Simple Type) AirbagDeployment Accepts Null Yes

Field Values -25 -5 2220 2230

Not Applicable Not Available No Airbag Deployed Airbag Deployed Side

-10 2215 2225 2235

Not Known No Airbag Present Airbag Deployed Front Airbag Deployed Other (knee, airbelt, etc.)



Data Collector ● EMS personnel if Possible Injury (E09_04) is answered Yes and there is a vehicle involved


Common Null Values



Safety Equipment


● NFIRS 5.0 EMS Module; Title: Safety Equipment; Multiple Select Pick-List: Safety, Seat Belts =1, Child Safety Seat = 2, Airbag = 3, Helmet = 4, Protective Clothing = 5, Flotation Device = 6, None or No Safety Equipment = N, Other Safety Equipment Used = O, Undetermined Safety Equipment = U

State Regulations ● Nebraska Trauma Regulation 3.G

Section E10

Situation/ Trauma


Page 274 of 463

Section

E11

Situation/ CPR

Section E11

Situation/ CPR


Page 276 of 463

DATE/TIME RESUSCITATION DISCONTINUED E11_09 Data Format [date/time] Definition The date/time the CPR was discontinued (or could be time of death) XSD Data Type xs:dateTime Multiple Entry Configuration No Required in XSD No



Additional Information ● Complete only if Cardiac Arrest (E11_01) is “Yes” ● If the date/time is electronically stored within a database or transmitted via XML as a “tick”, the referenced variables may also be used

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows for evaluation of Cardiac Arrest data for Quality Improvement of patient care and agency response

Data Collector ● EMS personnel if Cardiac Arrest (E11_01) is answered Yes



Time CPR Discontinued


Section E11

Situation/ CPR


Page 285 of 463

Section E12

Medical History

Section E12

Medical History


Page 288 of 463

BARRIERS TO PATIENT CARE

National Element


E12_01

Definition Indication of whether or not there were any patient specific barriers to serving the patient at the scene XSD Data Type xs:integer Multiple Entry Configuration Yes Required in XSD Yes

XSD Domain (Simple Type) BarriersToPatientCare Accepts Null Yes

Field Values -25 -10 2600 2610 2620 2630 2640

Not Applicable Not Known Developmentally Impaired Language Physically Impaired Speech Impaired Unconscious

-15 -5 2605 2615 2625 2635

Not Reporting Not Available Hearing Impaired None Physically Restrained Unattended or Unsupervised (including minors)

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on any barriers to patient care ● Allows data to describe any barriers to care within the EMS agency which is important to many federal initiatives



Common Null Values





● NFIRS 5.0 EMS Module; Title: Human Factors; Describes the human factors that contributed to the patient’s injury; PickList: Asleep = 1, Unconscious = 2, Possibly Impaired by Alcohol = 3, Possibly Impaired by Other Drug or Chemical = 4, Possibly Mentally Disabled = 5, Physically Disabled = 6, Physically Restrained = 7, Unattended or Unsupervised Person, Included are too young to act = 8, None or No Human Factors = N


Section E12

Medical History


Page 289 of 463

MEDICATION ALLERGIES E12_08 Data Format [combo] multiple-choice Definition The patient’s medication allergies XSD Data Type xs:string Multiple Entry Configuration Yes Required in XSD No

XSD Domain (Simple Type) MedicationAllergies Accepts Null Yes Minimum Constraint 2 Maximum Constraint 30

Field Values -25 Not Applicable -5 Not Available ● NKDA (No Known Drug Allergies)


Additional Information ● A Drug List should be created to serve as a list box which can contain any generic or trade name of a drug approved by the FDA ● Alternatively, the drugs may be entered as a multiple entry text configuration

Uses ● Part of an EMS Medical Record



Section E12

Medical History



Page 296 of 463

ENVIRONMENTAL/FOOD ALLERGIES E12_09 Data Format [combo] multiple-choice Definition The patient’s known allergies to food or environmental agents. XSD Data Type xs:integer Multiple Entry Configuration Yes Required in XSD No

XSD Domain (Simple Type) EnvironmentalFoodAllergies Accepts Null Yes

Field Values -25 -5 2680 2690 2700

Not Applicable Not Available Food Allergy Chemical None

-10 2675 2685 2695

Not Known Insect Sting Latex Other






Section E12

Medical History


Page 297 of 463

MEDICAL/SURGICAL HISTORY E12_10 Data Format [combo or text] multiple-choice Definition The patient’s pre-existing medical and surgery history of the patient XSD Data Type xs:string Multiple Entry Configuration Yes Required in XSD No

XSD Domain (Simple Type) MedicalSurgicalHistory Accepts Null Yes Minimum Constraint 2 Maximum Constraint 30



Additional Information ● A Medical/Surgical History list should be created to serve as a listbox which can contain any ICD-9 coded diagnosis or procedure ● The field should store the values of the ICD-9 codes since CMS has not adopted ICD-10 level codes at the time of this document






Pre-Existing Condition


Section E12

Medical History


Page 298 of 463

MEDICAL HISTORY OBTAINED FROM E12_11 Data Format [combo] single-choice Definition Type of person medical history obtained from XSD Data Type xs:integer Multiple Entry Configuration No Required in XSD No

XSD Domain (Simple Type) MedicalHistoryObtainedFrom Accepts Null Yes

Field Values -25 -5 2710 2720

Not Applicable Not Available Family None

-10 2705 2715 2725

Not Known Bystander/Other Health Care Personnel Patient




Section E12

Medical History


Page 299 of 463


IMMUNIZATION HISTORY E12_12 Data Format [combo] multiple-choice

Definition The type of immunization the patient has received. XSD Data Type xs:integer XSD Domain (Simple Type) ImmunizationType Multiple Entry Configuration Yes, via structure Accepts Null No Required in XSD No XSD Structure: E12_12 and E12_13 are members of E12_12_0 Immunization History Structure

Field Values 2730 2740 2750 2760 2770 2780

Anthrax Hemophilus Influenza B Hepatitis B MMR (Measles, Mumps, Rubella) Small Pox Varicella

2735 2745 2755 2765 2775

DPT (Diphtheria, Tetanus, Pertussis) Hepatitis A Influenza (Flu) Polio = 8, Pneumococcal (pneumonia) Tetanus

Uses ● Part of the Medical History of the patient and could be important in a Bioterrorism event


Other Associated Elements E01_01 Patient Care Report Number E12_13 Immunization Date

E06_01 Last Name


Section E12

Medical History


Page 300 of 463

IMMUNIZATION DATE E12_13 Data Format [text] Definition The date of the associated immunization type. XSD Data Type xs:date XSD Domain (Simple Type) ImmunizationDate Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No Minimum Constraint 1890 Maximum Constraint 2030 XSD Structure: E12_12 and E12_13 are members of E12_12_0 Immunization History Structure



Additional Information ● Could be configured with a list box of years formatted as YYYY ● Format [YYYY]

Uses ● Part of the Medical History of the patient and could be important in a Bioterrorism event


Other Associated Elements E00 Common Null Values E12_12 Immunization History



Section E12

Medical History


Page 301 of 463

CURRENT MEDICATIONS E12_14 Data Format [combo or text] multiple-choice Definition The medications the patient currently takes XSD Data Type xs:string XSD Domain (Simple Type) CurrentMedicationName Multiple Entry Configuration Yes, via structure Accepts Null No Required in XSD No Minimum Constraint 2 Maximum Constraint 30 XSD Structure: (1) E12_14, E12_15, E12_16, and E12_17 are all members of E12_14_0 Current Medications Structure. (2) E12_15 and E12_16 are members of E12_15_0 Current Medication Dose Structure


Additional Information ● A Drug List should be created to serve as a listbox which can contain any generic or trade name of a drug approved by the FDA ● Alternatively, the drugs may be entered as a multiple entry text configuration ● The Drug List should also include “None”



Other Associated Elements E01_01 Patient Care Report Number E12_16 Current Medication Dosage Unit

E12_15 Current Medication Dose E12_17 Current Medication Administration Route



Medical History Page 302 of 463

CURRENT MEDICATION DOSE E12_15 Data Format [number] Definition The numeric dose or amount of the patient’s current medication XSD Data Type xs:decimal XSD Domain (Simple Type) CurrentMedicationDose Multiple Entry Configuration Yes, via structure Accepts Null No Required in XSD No Minimum Constraint 0 Maximum Constraint 999999.99 XSD Structure: (1) E12_14, E12_15, E12_16, and E12_17 are all members of E12_14_0 Current Medications Structure. (2) E12_15 and E12_16 are members of E12_15_0 Current Medication Dose Structure




Other Associated Elements E01_01 Patient Care Report Number E12_16 Current Medication Dosage Unit

E12_14 Current Medications E12_17 Current Medication Administration Route



Medical History Page 303 of 463

CURRENT MEDICATION DOSAGE UNIT E12_16 Data Format [combo] single-choice Definition The dosage unit of the patient’s current medication XSD Data Type xs:integer XSD Domain (Simple Type) CurrentMedicationDosageUnit Multiple Entry Configuration Yes, via structure Accepts Null No Required in XSD No XSD Structure: (1) E12_14, E12_15, E12_16, and E12_17 are all members of E12_14_0 Current Medications Structure. (2) E12_15 and E12_16 are members of E12_15_0 Current Medication Dose Structure

Field Values 2785 2795 2805 2815 2825 2835 2845 2855

GMS IU L/MIN LPM MCG/KG/MIN MG ML Other

2790 2800 2810 2820 2830 2840 2850 2860

Inches KVO (TKO) LITERS MCG MEQ MG/KG/MIN ML/HR Puffs



Other Associated Elements E01_01 Patient Care Report Number E12_15 Current Medication Dose

E12_14 Current Medications E12_17 Current Medication Administration Route

References to Other Databases ● DEEDS DEEDS/HL-7 Version 2.3


Section E12

Medical History


Page 304 of 463

CURRENT MEDICATION ADMINISTRATION ROUTE E12_17 Data Format [combo] single-choice Definition The administration route (po, SQ, etc.) of the patients current medication XSD Data Type xs:integer XSD Domain (Simple Type) CurrentMedicationAdministrationRoute Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: (1) E12_14, E12_15, E12_16, and E12_17 are all members of E12_14_0 Current Medications Structure. (2) E12_15 and E12_16 are members of E12_15_0 Current Medication Dose Structure

Field Values -25 -5 2870 2880 2895 2905 2915 2925 2935 2945 2955 2965 2975

Not Applicable Not Available Gastrostomy Intramuscular Intravenous Nasal prongs Ophthalmic Other/miscellaneous Non Re-breather mask Subcutaneous Topical Transdermal Ventimask

-10 2865 2875 2890 2900 2910 2920 2930 2940 2950 2960 2970 2980

Not Known Endotracheal tube Inhalation Intraocular Nasal Nasogastric Oral Otic Rectal Sublingual Tracheostomy Urethral Wound



Other Associated Elements E00 Common Null Values E12_14 Current Medications E12_16 Current Medication Dosage Unit

E01_01 Patient Care Report Number E12_15 Current Medication Dose


● DEEDS DEEDS/HL-7 Version 2.3; [combo] Apply externally = AP, Buccal = B, Dental = DT, Epidural = EP, Endotracheal tube = ET, Gastronomy tube = GTT, Genitourinary irrigant = GU, Intraarterial = IA, Intrabursal = IB, Intracardiac = IC, Intracervical (uterus) = IC


Section E12

Medical History


Page 305 of 463

PREGNANCY E12_20 Data Format [combo] single-choice Definition Indication of the possibility by the patient’s history of current pregnancy XSD Data Type xs:integer Multiple Entry Configuration No Required in XSD No

XSD Domain (Simple Type) YesNoValues Accepts Null Yes

Field Values -25 Not Applicable -5 Not Available 1 Yes

-10 Not Known 0 No




Common Null Values



Section E12

Medical History


Page 308 of 463

Section E14

Assessment/ Vital Signs

Section E14



Page 311 of 463

DATE/TIME VITAL SIGNS TAKEN E14_01 Data Format [date/time] Definition Date/Time Vital Signs Taken XSD Data Type xs:dateTime XSD Domain (Simple Type) DateTime Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 1990 Maximum Constraint 2030 XSD Structure: Each element is section E14 is associated with a E14_01 Date/Time


Additional Information ● If the date/time is electronically stored within a database or transmitted via XML as a “tick”, the referenced variables may also be used ● Multiple Entry Configuration to allow multiple sets of Vital Signs

Uses ● Part of an EMS Medical Record ● Provides documentation of Assessment and Care ● Used in Quality Management for the evaluation of Care and EMS Agency Performance

Data Collector ● EMS personnel or may be provided electronically through a medical device



● NFIRS 5.0 EMS Module; Title: Patient Pulse; Presence of a Pulse at the time of patient transfer to another service.; PickList: Pulse on Transfer = 1, No; Pulse of Transfer = 2


Section E14



Page 312 of 463

OBTAINED PRIOR TO THIS UNITS EMS CARE E14_02 Data Format [combo] single-choice Definition Indicates that the information which is documented was obtained prior to the EMS unit's care creting this patient care report XSD Data Type xs:integer XSD Domain (Simple Type) YesNoValues Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: Each element is section E14 is associated with a E14_01 Date/Time


-10 Not Known 0 No

Additional Information ● If E14_02 is “Yes”, the Date/Time Vital Signs Taken (E14_01) is not required



Other Associated Elements E00 Common Null Values E14_01 Date/Time Vital Signs Taken



Section E14



Page 313 of 463

SBP (SYSTOLIC BLOOD PRESSURE) E14_04 Data Format [number] Definition The patient's systolic blood pressure XSD Data Type xs:integer XSD Domain (Simple Type) SBP Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 0 Maximum Constraint 400 XSD Structure: (1) Each element is section E14 is associated with a E14_01 Date/Time. (2) E14_04, E14_05, and E14_06 are all members of E14_04_0 Blood Pressure Structure


Additional Information ● Could be collected from Device Systolic Blood Pressure (E21_14)



Other Associated Elements E01_01 Patient Care Report Number E14_05 DBP (Diastolic Blood Pressure)

E14_01 Date/Time Vital Signs Taken E14_06 Method of Blood Pressure Measurement


Systolic Blood Pressure

State Regulations ● Nebraska EMS Regulation 7 ● Nebraska Trauma Regulation 4.F.1



Page 315 of 463

DBP (DIASTOLIC BLOOD PRESSURE) E14_05 Data Format [number] Definition The patient's diastolic blood pressure XSD Data Type xs:integer XSD Domain (Simple Type) DBP Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 0 Maximum Constraint 300 XSD Structure: (1) Each element is section E14 is associated with a E14_01 Date/Time. (2) E14_04, E14_05, and E14_06 are all members of E14_04_0 Blood Pressure Structure


Additional Information ● Could be collected from Device Diastolic Blood Pressure (E21_15)



Other Associated Elements E01_01 Patient Care Report Number E14_04 SBP (Systolic Blood Pressure)

E14_01 Date/Time Vital Signs Taken E14_06 Method of Blood Pressure Measurement


Diastolic Blood Pressure




Page 316 of 463

METHOD OF BLOOD PRESSURE MEASUREMENT E14_06 Data Format [combo] single-choice Definition Indication of method of blood pressure procedure. XSD Data Type xs:integer XSD Domain (Simple Type) MethodOfBloodPressure Multiple Entry Configuration Yes, via structure Accepts Null No Required in XSD No XSD Structure: (1) Each element is section E14 is associated with a E14_01 Date/Time. (2) E14_04, E14_05, and E14_06 are all members of E14_04_0 Blood Pressure Structure

Field Values 3150 Arterial Line 3160 Manual Cuff 3170 Venous Line

3155 Automated Cuff 3165 Palpated Cuff



Other Associated Elements E01_01 Patient Care Report Number E14_04 SBP (Systolic Blood Pressure)

E14_01 Date/Time Vital Signs Taken E14_05 DBP (Diastolic Blood Pressure)




Page 317 of 463

PULSE RATE E14_07 Data Format [number] Definition The patient's pulse rate, palpated or auscultated, expressed as a number per minute XSD Data Type xs:integer XSD Domain (Simple Type) PulseRate Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 0 Maximum Constraint 500 XSD Structure: Each element is section E14 is associated with a E14_01 Date/Time


Additional Information ● Could be collected from Device Pulse Rate (E21_13)




E14_01 Date/Time Vital Signs Taken


Pulse Rate


● NFIRS 5.0 EMS Module; Title: Patient Pulse; Presence of a Pulse at the time of patient transfer to another service.; PickList: Pulse on Transfer = 1, No; Pulse of Transfer = 2


Section E14



Page 318 of 463

PULSE RHYTHM E14_10 Data Format [combo] single-choice Definition The clinical rhythm of the patients pulse (regular, irregular, etc.) XSD Data Type xs:integer XSD Domain (Simple Type) PulseRhythm Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: Each element is section E14 is associated with a E14_01 Date/Time

Field Values -25 Not Applicable -5 Not Available 3180 Irregular

-10 Not Known 3175 Regular






Section E14



Page 321 of 463

RESPIRATORY RATE E14_11 Data Format [number] Definition The patient's respiratory rate expressed as a number per minute XSD Data Type xs:integer XSD Domain (Simple Type) RespiratoryRate Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 0 Maximum Constraint 100 XSD Structure: Each element is section E14 is associated with a E14_01 Date/Time


Additional Information ● Could be collected from Device Respiratory Rate (E21_16)






Respiratory Rate


Section E14



Page 322 of 463

RESPIRATORY EFFORT E14_12 Data Format [text] Definition The patient’s respiratory effort XSD Data Type xs:integer XSD Domain (Simple Type) RespiratoryEffort Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: Each element is section E14 is associated with a E14_01 Date/Time

Field Values -25 -5 3190 3200

Not Applicable Not Available Labored Absent

-10 3185 3195 3205

Not Known Normal Fatigued Not Assessed






Respiratory Effort


Section E14



Page 323 of 463

GLASGOW COMA SCORE-EYE E14_15 Data Format [number] Definition The patient's Glasgow Coma Score Eye opening XSD Data Type xs:integer XSD Domain (Simple Type) GCSEye Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 1 Maximum Constraint 4 XSD Structure: (1) Each element is section E14 is associated with a E14_01 Date/Time. (2) E14_15, E14_16, E14_17, and E14_18 are all members of E14_15_0 GCS Score Structure

Field Values ● ●

For All Age Groups: 1 = Does Not Open Eyes For All Age Groups: 2 = Opens Eyes to painful stimulation

● ●

●

For All Age Groups: 3 = Opens Eyes to verbal stimulation

●

●

For All Age Groups: 4 = Opens Eyes spontaneously

●

Additional Information ● Can be configured as a single choice list box



Other Associated Elements E01_01 Patient Care Report Number E14_16 Glasgow Coma Score-Verbal E14_18 Glasgow Coma Score-Qualifier

E14_01 Date/Time Vital Signs Taken E14_17 Glasgow Coma Score-Motor E14_19 Total Glasgow Coma Score


Glasgow Eye Opening Component


Section E14



Page 326 of 463

GLASGOW COMA SCORE-VERBAL E14_16 Data Format [number] Definition The patient's Glasgow Coma Score Verbal XSD Data Type xs:integer XSD Domain (Simple Type) GCSVerbal Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 1 Maximum Constraint 5 XSD Structure: (1) Each element is section E14 is associated with a E14_01 Date/Time. (2) E14_15, E14_16, E14_17, and E14_18 are all members of E14_15_0 GCS Score Structure

Field Values ● ● ● ● ●

Patients 0-23 months: 1 = None Patients 0-23 months: 2 = Persistent cry Patients 0-23 months: 3 = Inappropriate cry Patients 0-23 months: 4 = Cries, inconsolable Patients 0-23 months: 5 = Smiles, coos, cries appropriately

● ● ● Patients >5 years: 1 = None ● Patients >5 years: 2 = Non-specified sounds ● Patients >5 years: 3 = Inappropriate words ● Patients >5 years: 4 = Confused conversation or speech ● Patients >5 years: 5 = Oriented and appropriate speech

● ● ● ● ●

Patients 2-5 years: Patients 2-5 years: Patients 2-5 years: Patients 2-5 years: Patients 2-5 years:

1 = None 2 = Grunts 3 = Cries and/or screams 4 = Inappropriate words 5 = Appropriate words

● ● ● ●




Other Associated Elements E01_01 Patient Care Report Number E14_15 Glasgow Coma Score-Eye E14_18 Glasgow Coma Score-Qualifier

E14_01 Date/Time Vital Signs Taken E14_17 Glasgow Coma Score-Motor E14_19 Total Glasgow Coma Score

References in NHTSA Version 1 Essential Element 74a Essential Element 74b Essential Element 74c

Glasgow Verbal Component For patients >5 years Glasgow Verbal Component For patients 2-5 years Glasgow Verbal Component for patients 0-23 months


Section E14



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GLASGOW COMA SCORE-MOTOR E14_17 Data Format [number] Definition The patient's Glasgow Coma Score Motor XSD Data Type xs:integer XSD Domain (Simple Type) GCSMotor Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 1 Maximum Constraint 6 XSD Structure: (1) Each element is section E14 is associated with a E14_01 Date/Time. (2) E14_15, E14_16, E14_17, and E14_18 are all members of E14_15_0 GCS Score Structure

Field Values ● Patients up to 5 years: 1 = None ● Patients up to 5 years: 2 = Extensor posturing in response response to to painful stimulation ● Patients up to 5 years: 3 = Flexor posturing in response to response to painful stimulation ● Patients up to 5 years: 4 = General withdrawal in response to response to painful stimulation ● Patients up to 5 years: 5 = Localization of painful stimulation stimulation ● appropriate

● ●

Patients >5 years: 1 = None Patients >5 years: 2 = Extensor posturing in

painful stimulation ● Patients >5 years: 3 = Flexor posturing in painful stimulation ● Patients >5 years: 4 = General withdrawal in painful stimulation ● Patients >5 years: 5 = Localization of painful

Patients up to 5 years: 6 = Spontaneous ●

Patients >5 years: 6 = Obeys commands with

motor responses




Other Associated Elements E01_01 Patient Care Report Number E14_15 Glasgow Coma Score-Eye E14_18 Glasgow Coma Score-Qualifier

E14_01 Date/Time Vital Signs Taken E14_16 Glasgow Coma Score-Verbal E14_19 Total Glasgow Coma Score

References in NHTSA Version 1 Essential Element 75a Essential Element 75b

Glasgow Motor Component For patients >5 years Glasgow Motor Component For patients up to 5 years


Section

E14 Assessment/ Vital Signs


Page 328 of 463

GLASGOW COMA SCORE-QUALIFIER E14_18 Data Format [combo] single-choice Definition Documentation of factors which make the GCS score more meaningful. XSD Data Type xs:integer XSD Domain (Simple Type) GCSQualifier Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: (1) Each element is section E14 is associated with a E14_01 Date/Time. (2) E14_15, E14_16, E14_17, and E14_18 are all members of E14_15_0 GCS Score Structure

Field Values -25 Not Applicable -5 Not Available such 3215 Patient Chemically Sedated 3225 Patient Intubated and Chemically Paralyzed

-10 Not Known 3210 Initial GCS has legitimate values without interventions as intubation and sedation 3220 Patient Intubated




Other Associated Elements E00 E14_01 E14_16 E14_19

Common Null Values Date/Time Vital Signs Taken Glasgow Coma Score-Verbal Total Glasgow Coma Score

E01_01 Patient Care Report Number E14_15 Glasgow Coma Score-Eye E14_17 Glasgow Coma Score-Motor




Page 329 of 463

TOTAL GLASGOW COMA SCORE E14_19 Data Format [number] Definition The patient's total Glasgow Coma Score XSD Data Type xs:integer XSD Domain (Simple Type) TotalGCS Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 1 Maximum Constraint 15 XSD Structure: Each element is section E14 is associated with a E14_01 Date/Time


Additional Information ● Calculated from Glasgow Coma Score-Eye (E14_15), Glasgow Coma Score-Verbal (E14_16), and Glasgow Coma ScoreMotor (E14_17)


Data Collector ● EMS personnel but could be auto-generated based on the information entered into an electronic patient care report

Other Associated Elements E01_01 Patient Care Report Number E14_15 Glasgow Coma Score-Eye E14_17 Glasgow Coma Score-Motor

E14_01 Date/Time Vital Signs Taken E14_16 Glasgow Coma Score-Verbal E14_18 Glasgow Coma Score-Qualifier


Glasgow Coma Score (Total)

State Regulation ● Nebraska EMS Regulation 23 ● Nebraska Trauma Regulation 4.F.4

Section E14



Page 330 of 463

REVISED TRAUMA SCORE E14_27 Data Format [number] Definition The patient's Revised Trauma Score XSD Data Type xs:integer XSD Domain (Simple Type) RTS Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 0 Maximum Constraint 12 XSD Structure: Each element is section E14 is associated with a E14_01 Date/Time


Additional Information ● Calculated based on 3 components ● Can be auto-calculated from Respiratory Rate (E14_11), Systolic Blood Pressure (E14_04), and Total GCS (E14_19), if all three components are documented at the same Time (E14_01) ● Neurological Component: 4 = Glasgow coma score 13 - 15, 3 = Glasgow coma score 9 - 12, 2 = Glasgow coma score 6 8, 1 = Glasgow coma score 4 - 5, 0 = Glasgow coma score 3 ● Respiratory Rate Component: 4 = 10 - 29 per minute, 3 = >29 per minute, 2 = 6 - 9 per minute, 1 = 1 - 5 per minute, 0 = None spontaneous ● Systolic Blood Pressure Component: 4 = >89 mm Hg, 3 = 76 - 89 mm Hg , 2 = 50 - 75 mm Hg, 1 = 1 - 49 mm Hg, 0 = No pulse






Revised Trauma Score




Page 338 of 463

PEDIATRIC TRAUMA SCORE E14_28 Data Format [number] Definition The Trauma Score for patients age 12 and under XSD Data Type xs:integer XSD Domain (Simple Type) PediatricTraumaScore Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint -6 Maximum Constraint 12 XSD Structure: Each element is section E14 is associated with a E14_01 Date/Time


Additional Information ● Age 12 and Under ● Calculated by adding the appropriate response for each of the 5 components below: ● Can be auto-calculated if programming logic is used to confirm all 5 components ● Component Airway: 2 = Normal, 1 = Maintainable, -1 = Un-maintainable or Intubated ● Component CNS: 2 = Awake, 1 = Altered Mental Status/Obtunded, -1 = Coma/Abnormal Flexion ● Component Open Wounds: 2 = None, 1 = Minor, -1 = Major/Penetrating ● Component Size: 2 = >20 kg, 1 = 10 – 20 kg, -1 = 90 mmHg (or palpable pulse at wrist), 1 = 50–90 mmHg (or palpable pulse at groin), -1 = < 50 mmHg (or no pulse palpable)






Section E14



Page 339 of 463

Section E18

Intervention/ Medication

Section E18



Page 379 of 463

DATE/TIME MEDICATION ADMINISTERED E18_01 Data Format [date/time] Definition The date/time medication administered to the patient XSD Data Type xs:dateTime XSD Domain (Simple Type) DateTime Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 1990 Maximum Constraint 2030 XSD Structure: All data elements section E18 are members of the E18 Medication Structure


Additional Information ● If the date/time is electronically stored within a database or transmitted via XML as a “tick”, the referenced variables may also be used ● This is a multiple entry configuration which will allow multiple medication administrations to be documented

Uses ● Part of an EMS Medical Record ● Reports on Medications and Skills performed along with Protocols used provide key performance evaluation tools ● Used in Quality Management for the evaluation of Care and EMS Agency Performance


Other Associated Elements E01_01 Patient Care Report Number E18_03 E18_05 E18_07 E18_09 E18_11

Medication Given Medication Dosage Response to Medication Medication Crew Member ID Medication Authorizing Physician

E18_02 Medication Administered Prior to this Units EMS Care E18_04 Medication Administered Route E18_06 Medication Dosage Units E18_08 Medication Complication E18_10 Medication Authorization

State Regulation ● Nebraska EMS Regulation 9, 25, 26

Section E18



Page 380 of 463

MEDICATION ADMINISTERED PRIOR TO THIS UNITS EMS CARE E18_02 Data Format [combo] single-choice Definition Indicates that the medication administration which is documented was administered prior to this EMS unit’s care. XSD Data Type xs:integer XSD Domain (Simple Type) YesNoValues Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: All data elements section E18 are members of the E18 Medication Structure


-10 Not Known 0 No

Additional Information ● If E18_02 is “Yes”, the Date/Time Medication Administered (E18_01) is not required



Other Associated Elements E00 E18_01 E18_04 E18_06 E18_08 E18_10

Common Null Values Date/Time Medication Administered Medication Administered Route Medication Dosage Units Medication Complication Medication Authorization

E01_01 E18_03 E18_05 E18_07 E18_09 E18_11

Patient Care Report Number Medication Given Medication Dosage Response to Medication Medication Crew Member ID Medication Authorizing Physician

State Regulation ● Nebraska EMS Regulation 9, 13

Section E18



Page 381 of 463

MEDICATION GIVEN Data Format [combo] single-choice

National Element

E18_03

Definition The medication given to the patient XSD Data Type xs:string XSD Domain (Simple Type) MedicationsGiven Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD Yes Minimum Constraint 2 Maximum Constraint 30 XSD Structure: All data elements section E18 are members of the E18 Medication Structure



Additional Information ● List created from Medications (D04_06)

Uses ● Allows data to be sorted based on the medical treatment ● Allows data to describe the medications administered by EMS ● Part of an EMS Medical Record ● Reports on Medications and Skills performed along with Protocols used provide key performance evaluation tools ● Used in Quality Management for the evaluation of Care and EMS Agency Performance


Other Associated Elements E00 Common Null Values E18_01 Date/Time Medication Administered E18_04 E18_06 E18_08 E18_10

Medication Administered Route Medication Dosage Units Medication Complication Medication Authorization

E01_01 Patient Care Report Number E18_02 Medication Administered Prior to this Units EMS Care E18_05 Medication Dosage E18_07 Response to Medication E18_09 Medication Crew Member ID E18_11 Medication Authorizing Physician


Medication Name


● NFIRS 5.0 EMS Module, Title: Procedures Used, Multi Select List: Airway Insertion = 01, Anti-Shock Trousers = 02, Assisted Ventilation = 03, Bleeding Control = 04, Burn Care = 05, Cardiac Pacing = 06, Cardioversion (defib), Manual = 07, Chest/Abdominal Thrust = 08, CPR = 09, Cricothyroidotomy = 10, Defibrillation by AED = 11, EKG Monitoring = 12, Extrication = 13, Intubation (EGTA) = 14, Intubation (ET) = 15, IO/IV Therapy = 16, Medications Therapy = 17, Oxygen Therapy = 18, Obstetrical Care/Delivery = 19, Pre-Arrival Instruction = 20, Restrained Patient = 21, Spinal Immobilization = 22, Splinted Extremities = 23, Suction/Aspirate = 24, Other Procedure = 00, No Treatment = NN


Section E18



Page 382 of 463

MEDICATION ADMINISTERED ROUTE E18_04 Data Format [combo] single-choice Definition The route that the medication was administered to the patient. XSD Data Type xs:integer XSD Domain (Simple Type) MedicationAdministeredRoute Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: All data elements section E18 are members of the E18 Medication Structure

Field Values -25 -5 4180 4190 4200 4210 4220 4230 4240 4250 4260 4270 4280 4290

Not Applicable Not Available Gastrostomy tube Intramuscular Intraocular Nasal Nasogastric Oral Otic Rectal Sublingual Tracheostomy Urethral Wound

-10 4175 4185 4191 4205 4215 4225 4235 4245 4255 4265 4275 4285

Not Known Endotracheal tube Inhalation Intraosseous Intravenous Nasal prongs Ophthalmic Other/miscellaneous Re-breather mask Subcutaneous Topical Transdermal Ventimask




Medication Given Medication Dosage Units Medication Complication Medication Authorization

E01_01 Patient Care Report Number E18_02 Medication Administered Prior to this Units EMS Care E18_05 Medication Dosage E18_07 Response to Medication E18_09 Medication Crew Member ID E18_11 Medication Authorizing Physician


● DEEDS DEEDS/HL-7 Version 2.3; [combo] Apply externally = AP, Buccal = B, Dental = DT, Epidural = EP, Endotracheal tube = ET, Gastronomy tube = GTT, Genitourinary irrigant = GU, Intraarterial = IA, Intrabursal = IB, Intracardiac = IC, Intracervical (uterus) = IC


Section E18



Page 383 of 463

MEDICATION DOSAGE E18_05 Data Format [number] Definition The dose or amount of medication given to the patient XSD Data Type xs:decimal XSD Domain (Simple Type) MedicationDosage Multiple Entry Configuration Yes, via structure Accepts Null No Required in XSD No Minimum Constraint 0 Maximum Constraint 999999.99 XSD Structure: (1) All data elements section E18 are members of the E18 Medication Structure. (2) E18_05 and E18_06 are members of E18_05_0 Medication Dosing Structure




Other Associated Elements E01_01 Patient Care Report Number E18_02 Medication Administered Prior to this Units EMS Care E18_04 Medication Administered Route E18_07 Response to Medication E18_09 Medication Crew Member ID E18_11 Medication Authorizing Physician

E18_01 Date/Time Medication Administered E18_03 Medication Given E18_06 Medication Dosage Units E18_08 Medication Complication E18_10 Medication Authorization


Section E18



Page 384 of 463

MEDICATION DOSAGE UNITS E18_06 Data Format [combo] single-choice Definition The units of medication dosage given to patient XSD Data Type xs:integer XSD Domain (Simple Type) MedicationDosageUnits Multiple Entry Configuration Yes, via structure Accepts Null No Required in XSD No XSD Structure: (1) All data elements section E18 are members of the E18 Medication Structure. (2) E18_05 and E18_06 are members of E18_05_0 Medication Dosing Structure

Field Values 4295 4305 4315 4325 4335 4345 4355 4365

GMS IU L/MIN LPM MCG/KG/MIN MG ML Other

4300 4310 4320 4330 4340 4350 4360 4370

Inches KVO (TKO) LITERS MCG MEQ MG/KG/MIN ML/HR Puffs



Other Associated Elements E01_01 Patient Care Report Number E18_02 Medication Administered Prior to this Units EMS Care E18_03 Medication Given E18_05 Medication Dosage E18_08 Medication Complication E18_10 Medication Authorization

E18_01 Date/Time Medication Administered E18_03 Medication Given E18_04 E18_07 E18_09 E18_11

Medication Administered Route Response to Medication Medication Crew Member ID Medication Authorizing Physician

References to Other Databases ● DEEDS DEEDS/HL-7 Version 2.3


Section E18



Page 385 of 463

RESPONSE TO MEDICATION E18_07 Data Format [combo] single-choice Definition The patient’s response to the medication. XSD Data Type xs:integer XSD Domain (Simple Type) ResponseToMedication Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: All data elements section E18 are members of the E18 Medication Structure

Field Values -25 Not Applicable -5 Not Available 4380 Unchanged

-10 Not Known 4375 Improved 4385 Worse




Medication Given Medication Dosage Medication Complication Medication Authorization

E01_01 Patient Care Report Number E18_02 Medication Administered Prior to this Units EMS Care E18_04 Medication Administered Route E18_06 Medication Dosage Units E18_09 Medication Crew Member ID E18_11 Medication Authorizing Physician

State Regulation ● Nebraska EMS Regulation 9

Section E18



Page 386 of 463

MEDICATION CREW MEMBER ID E18_09 Data Format [text] Definition The statewide assigned ID number of the EMS crew member giving the treatment to the patient XSD Data Type xs:integer XSD Domain (Simple Type) CrewMemberID Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No Minimum Constraint 2 Maximum Constraint 15 XSD Structure: All data elements section E18 are members of the E18 Medication Structure



Additional Information ● Linked to State/Licensure ID Number (D07_02) ● List box created from the State/Licensure ID Number (D07_02) which could display the Personnel’s Names as associated with D08_01, D08_02, and D08_03 for easy data entry

Uses ● Part of an EMS Medical Record and to document Medication Administration ● Reports on Medications and Skills performed along with Protocols used provide key performance evaluation tools ● Used in Quality Management for the evaluation of Care and EMS Agency Performance



Medication Given Medication Dosage Response to Medication Medication Authorization

E01_01 Patient Care Report Number E18_02 Medication Administered Prior to this Units EMS Care E18_04 Medication Administered Route E18_06 Medication Dosage Units E18_08 Medication Complication E18_11 Medication Authorizing Physician




Section E18



Page 388 of 463

MEDICATION AUTHORIZATION E18_10 Data Format [combo] single-choice Definition The type of treatment authorization obtained XSD Data Type xs:integer XSD Domain (Simple Type) MedicationAuthorization Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: All data elements section E18 are members of the E18 Medication Structure

Field Values -25 -5 4485 4495

Not Applicable Not Available On-Scene Written Orders (Patient Specific)

-10 Not Known 4480 On-Line 4490 Protocol (Standing Order)

Additional Information ● Associated with Medication Authorization (E18_11) if the value is not “Protocol”



Other Associated Elements E00 Common Null Values E18_01 Date/Time Medication Administered E18_03 E18_05 E18_07 E18_09 E18_11

Medication Given Medication Dosage Response to Medication Medication Crew Member ID Medication Authorizing Physician

E01_01 Patient Care Report Number E18_02 Medication Administered Prior to this Units EMS Care E18_04 Medication Administered Route E18_06 Medication Dosage Units E18_08 Medication Complication E18_11 Medication Authorizing Physician


Treatment Authorization


Section E18



Page 389 of 463

Section E19

Intervention/ Procedure

Section E19



Page 391 of 463

DATE/TIME PROCEDURE PERFORMED SUCCESSFULLY E19_01 Data Format [date/time] Definition The date and time the procedure was performed on the patient XSD Data Type xs:dateTime XSD Domain (Simple Type) DateTime Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 1990 Maximum Constraint 2030 XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure


Additional Information ● If the date/time is electronically stored within a database or transmitted via XML as a “tick”, the referenced variables may also be used ● This is a multiple entry configuration which will allow for multiple procedures to be documented



Other Associated Elements E01_01 Patient Care Report Number E19_03 E19_05 E19_07 E19_09 E19_11 E19_13

Procedure Number of Procedure Attempts Procedure Complication Procedure Crew Members ID Procedure Authorizing Physician Tube Confirmation

E19_02 Procedure Performed Prior to this Units EMS Care E19_04 Size of Procedure Equipment E19_06 Procedure Successful E19_08 Response to Procedure E19_10 Procedure Authorization E19_12 Successful IV Site E19_14 Destination Confirmation of Tube Placement


Time of First CPR Time of First Defibrillatory Shock


Section E19



Page 392 of 463

PROCEDURE PERFORMED PRIOR TO THIS UNITS EMS CARE E19_02 Data Format [combo] single-choice Definition Indicates that the procedure which was performed and documented was performed prior to this EMS unit’s care. XSD Data Type xs:integer XSD Domain (Simple Type) YesNoValues Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure


-10 Not Known 0 No

Additional Information ● If E19_02 is “Yes”, the Date/Time Medication Administered (E19_01) is not required



Other Associated Elements E00 Common Null Values E01_01 Patient Care Report Number E19_01 Date/Time Procedure Performed Successfully E19_03 Procedure E19_04 E19_06 E19_08 E19_10

Size of Procedure Equipment Procedure Successful Response to Procedure Procedure Authorization

E19_05 E19_07 E19_09 E19_11

Number of Procedure Attempts Procedure Complication Procedure Crew Members ID Procedure Authorizing Physician


Section E19



Page 393 of 463

PROCEDURE Data Format [combo] single-choice

National Element

E19_03

Definition The procedure performed on the patient. XSD Data Type xs:decimal XSD Domain (Simple Type) Procedure Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD Yes Minimum Constraint 0 Maximum Constraint 999.999 XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure



Additional Information ● List created from Procedures (D04_04)

Uses ● Allows data to be sorted based on the medical treatment ● Allows data to describe the procedures which are performed by EMS ● Part of an EMS Medical Record ● Reports on Medications and Skills performed along with Protocols used provide key performance evaluation tools ● Used in Quality Management for the evaluation of Care and EMS Agency Performance


Other Associated Elements E00 Common Null Values E01_01 Patient Care Report Number E19_01 Date/Time Procedure Performed Successfully E19_02 Procedure Performed Prior to this Units EMS Care E19_04 Size of Procedure Equipment E19_05 Number of Procedure Attempts E19_06 Procedure Successful E19_07 Procedure Complication E19_08 Response to Procedure E19_09 Procedure Crew Members ID E19_10 Procedure Authorization E19_11 Procedure Authorizing Physician


Time of First CPR Time of First Defibrillatory Shock


● NFIRS 5.0 EMS Module, Title: Procedures Used, Multi Select List: Airway Insertion = 01, Anti-Shock Trousers = 02, Assisted Ventilation = 03, Bleeding Control = 04, Burn Care = 05, Cardiac Pacing = 06, Cardioversion (defib), Manual = 07, Chest/Abdominal Thrust = 08, CPR = 09, Cricothyroidotomy = 10, Defibrillation by AED = 11, EKG Monitoring = 12, Extrication = 13, Intubation (EGTA) = 14, Intubation (ET) = 15, IO/IV Therapy = 16, Medications Therapy = 17, Oxygen Therapy = 18, Obstetrical Care/Delivery = 19, Pre-Arrival Instruction = 20, Restrained Patient = 21, Spinal Immobilization = 22, Splinted Extremities = 23, Suction/Aspirate = 24, Other Procedure = 00, No Treatment = NN ● UTSTEIN Arrest after arrival of EMS could be documented by CPR or Defibrillation performed along with the Cardiac Arrest datapoint.; [text] Value or


Section E19



Page 394 of 463

SIZE OF PROCEDURE EQUIPMENT E19_04 Data Format [text] Definition The size of equipment used in the procedure on the patient XSD Data Type xs:string XSD Domain (Simple Type) SizeOfProcedureEquipment Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No Minimum Constraint 2 Maximum Constraint 20 XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure



Additional Information ● Can be entered as text or configured as a List Box with the specific size associated with each Procedure listed for each EMS Agency (D04_04) n the Demographic Dataset



Other Associated Elements E00 Common Null Values E01_01 Patient Care Report Number E19_01 Date/Time Procedure Performed Successfully E19_02 Procedure Performed Prior to this Units EMS Care E19_03 Procedure E19_05 Number of Procedure Attempts E19_06 Procedure Successful E19_07 Procedure Complication E19_08 Response to Procedure E19_09 Procedure Crew Members ID E19_10 Procedure Authorization E19_11 Procedure Authorizing Physician

References in NHTSA Version 1 Essential Element 78 Procedure or Treatment Name


Section E19



Page 395 of 463

NUMBER OF PROCEDURE ATTEMPTS Data Format [number]

National Element

E19_05

Definition The number of attempts taken to complete a procedure or intervention regardless of success XSD Data Type xs:integer XSD Domain (Simple Type) NumberOfProcedureAttempts Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD Yes Minimum Constraint -25 Maximum Constraint 100 XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure



Uses ● Allows data to be sorted based on the medical treatment ● Allows data to describe the procedures which are performed by EMS ● Part of an EMS Medical Record ● Reports on Medications and Skills performed along with Protocols used provide key performance evaluation tools ● Used in Quality Management for the evaluation of Care and EMS Agency Performance


Other Associated Elements E00 Common Null Values E01_01 Patient Care Report Number E19_01 Date/Time Procedure Performed Successfully E19_02 Procedure Performed Prior to this Units EMS Care E19_03 Procedure E19_04 Size of Procedure Equipment E19_06 Procedure Successful E19_07 Procedure Complication E19_08 Response to Procedure E19_09 Procedure Crew Members ID E19_10 Procedure Authorization E19_11 Procedure Authorizing Physician


Section E19



Page 396 of 463

PROCEDURE SUCCESSFUL Data Format [combo] single-choice

National Element

E19_06

Definition Indication of whether or not the procedure performed on the patient was successful XSD Data Type xs:integer XSD Domain (Simple Type) YesNoValues Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD Yes XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure

Field Values -25 Not Applicable -10 Not Known 0 No

-15 Not Reporting -5 Not Available 1 Yes

Uses ● Allows data to be sorted based on the medical treatment ● Allows data to describe the procedures performed by EMS with respect to numbers and success rates ● Part of an EMS Medical Record ● Reports on Medications and Skills performed along with Protocols used provide key performance evaluation tools ● Used in Quality Management for the evaluation of Care and EMS Agency Performance


Other Associated Elements E00 Common Null Values E01_01 Patient Care Report Number E19_01 Date/Time Procedure Performed Successfully E19_02 Procedure Performed Prior to this Units EMS Care E19_03 Procedure E19_04 Size of Procedure Equipment E19_05 Number of Procedure Attempts E19_07 Procedure Complication E19_08 Response to Procedure E19_09 Procedure Crew Members ID E19_10 Procedure Authorization E19_11 Procedure Authorizing Physician


Section E19



Page 397 of 463

PROCEDURE COMPLICATION

National Element


E19_07

Definition Any complication associated with the performance of the procedure on the patient XSD Data Type xs:integer XSD Domain (Simple Type) ProcedureComplication Multiple Entry Configuration (1) Yes, via structure. (2) Yes Accepts Null Yes for each E14_01 Date/Time Required in XSD Yes XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure

Field Values -25 -10 4500 4510 4520 4530 4540 4550 4560 4570 4580 4590

Not Applicable Not Known None Apnea Bradycardia Esophageal Intubation-immediately Extravasion Hyperthermia Hypoxia Itching/Urticaria Other Tachycardia

-15 -5 4505 4515 4525 4535 4545 4555 4565 4575 4585 4595

Not Reporting Not Available Altered Mental Status Bleeding Diarrhea Esophageal Intubation-other Hypertension Hypotension Injury Nausea Respiratory Distress Vomiting

Uses ● Allows data to be sorted based on procedure complication ● Allows data to describe procedure complications which occur as a result of EMS treatment as part of a federal initiative to identify and reduce medical errors ● Part of an EMS Medical Record ● Reports on Medications and Skills performed along with Protocols used provide key performance evaluation tools ● Used in Quality Management for the evaluation of Care and EMS Agency Performance


Other Associated Elements E00 Common Null Values E01_01 Patient Care Report Number E19_01 Date/Time Procedure Performed Successfully E19_02 Procedure Performed Prior to this Units EMS Care E19_03 Procedure E19_04 Size of Procedure Equipment E19_05 Number of Procedure Attempts E19_06 Procedure Successful E19_08 Response to Procedure E19_09 Procedure Crew Members ID E19_10 Procedure Authorization E19_11 Procedure Authorizing Physician


Section E19



Page 398 of 463

RESPONSE TO PROCEDURE E19_08 Data Format [combo] single-choice Definition The patient’s response to the procedure XSD Data Type xs:integer XSD Domain (Simple Type) ResponseToProcedure Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure

Field Values -25 Not Applicable -5 Not Available 4605 Unchanged

-10 Not Known 4600 Improved 4610 Worse



Other Associated Elements E00 Common Null Values E01_01 Patient Care Report Number E19_01 Date/Time Procedure Performed Successfully E19_02 Procedure Performed Prior to this Units EMS Care E19_03 Procedure E19_04 Size of Procedure Equipment E19_05 Number of Procedure Attempts E19_06 Procedure Successful E19_07 Procedure Complication E19_09 Procedure Crew Members ID E19_10 Procedure Authorization E19_11 Procedure Authorizing Physician

State Regulation ● Nebraska EMS Regulation 9, 10

Section E19



Page 399 of 463

PROCEDURE CREW MEMBERS ID E19_09 Data Format [text] Definition The statewide assigned ID number of the EMS crew member performing the procedure on the patient XSD Data Type xs:integer XSD Domain (Simple Type) CrewMemberID Multiple Entry Configuration Yes, via structure Accepts Null Yes Required in XSD No Minimum Constraint 2 Maximum Constraint 15 XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure



Additional Information ● Linked to State/Licensure ID Number (D07_02) ● List box created from the State/Licensure ID Number (D07_02) which could display the Personnel’s Names as associated with D08_01, D08_02, and D08_03 for easy data entry

Uses ● Part of an EMS Medical Record and to document the Procedure performance ● Reports on Medications and Skills performed along with Protocols used provide key performance evaluation tools ● Used in Quality Management for the evaluation of Care and EMS Agency Performance


Other Associated Elements E00 Common Null Values E01_01 Patient Care Report Number E19_01 Date/Time Procedure Performed Successfully E19_02 Procedure Performed Prior to this Units EMS Care E19_03 Procedure E19_04 Size of Procedure Equipment E19_05 Number of Procedure Attempts E19_06 Procedure Successful E19_07 Procedure Complication E19_08 Response to Procedure E19_10 Procedure Authorization E19_11 Procedure Authorizing Physician




Section E19



Page 400 of 463

SUCCESSFUL IV SITE E19_12 Data Format [combo] multiple-choice Definition The location of the IV site (if applicable) on the patient XSD Data Type xs:integer XSD Domain (Simple Type) SuccessfulIVSite Multiple Entry Configuration Yes Accepts Null Yes Required in XSD No XSD Structure: Successful IV Site is not related to the documentation of any specific procedure. This data element is to be filled out based on the overall successful IV locations for any specific patient.

Field Values -25 -5 4640 4650 4660 4670 4680 4690 4700 4710 4720 4730

Not Applicable Not Available Antecubital-Right External Jugular-Right Femoral-Left Distal IO Femoral-Right IO Forearm-Right Hand-Right Lower Extremity-Right Scalp Tibia IO-Left Umbilical

-10 4635 4645 4655 4665 4675 4685 4695 4705 4715 4725

Not Known Antecubital-Left External Jugular-Left Femoral-Left IV Femoral-Right IV Forearm-Left Hand-Left Lower Extremity-Left Other Sternal IO Tibia IO-Right

Additional Information ● Successful IV Site is not related to the documentation of any specific procedure. This data element is to be filled out based on the overall successful IV locations for any specific patient.




Common Null Values



Section E19



Page 403 of 463

TUBE CONFIRMATION E19_13 Data Format [combo] multiple-choice Definition Endotracheal Tube placement verification at the time the airway procedure was done XSD Data Type xs:integer XSD Domain (Simple Type) TubeConfirmation Multiple Entry Configuration Yes Accepts Null Yes Required in XSD No XSD Structure: Tube Confirmation is not related to the documentation of any specific airway procedure but should be filled out if an airway procedure is done on any patient.

Field Values -25 -5 4740 4750 4760 4770

Not Applicable Not Available Colormetric CO2 Detector Confirmation Esophageal Bulb Aspiration confirmation Visualization of the Chest Rising with ventilation Waveform CO2 Confirmation

-10 4735 4745 4755 4765

Not Known Auscultation of Bilateral Breath Sounds Digital CO2 Confirmation Negative Auscultation of the Epigastrium Visualization of Tube Passing Through the Cords

Additional Information ● The Tube Confirmation is not documented with any specific Procedure (E19_03) but should be completed if an Airway Procedure leads to Intubation



Other Associated Elements E00 Common Null Values E19_03 Procedure



Section E19



Page 404 of 463

Section E20

Disposition

Section E20

Disposition


Page 406 of 463

DESTINATION/TRANSFERRED TO, NAME E20_01 Data Format [text] Definition The destination the patient was delivered or transferred to XSD Data Type xs:string Multiple Entry Configuration No Required in XSD No

XSD Domain (Simple Type) DestinationTransferredToID Accepts Null Yes Minimum Constraint 2 Maximum Constraint 50



Additional Information ● Could be an editable single choice list box derived from Hospitals Served (D04_11) and Other Destinations (D04_13)

Uses ● A component of the EMS Medical Record: Patient Care Report ● Important for grouping or comparing data by Destination location and type which also allows data to be sorted by geographic areas in many agencies ● Provides information on overall service area, patterns and times for agency configuration and evaluation


Other Associated Elements E00 Common Null Values E20_02 Destination/Transferred To, Code



Section E20

Disposition


Page 407 of 463

INCIDENT/PATIENT DISPOSITION

National Element


E20_10

Definition Type of disposition treatment and/or transport of the patient. XSD Data Type xs:integer Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) IncidentPatientDisposition Accepts Null No

Field Values 4815 4825 4835 4845 4855

Cancelled No Patient Found Patient Refused Care Treated, Transferred Care Treated, Transported by Law Enforcement

4820 4830 4840 4850 4860

Dead at Scene No Treatment Required Treated and Released Treated, Transported by EMS Treated, Transported by Private Vehicle

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on the EMS disposition ● Allows data to describe EMS patient’s disposition




Incident/Patient Disposition


● NFIRS 5.0 EMS Module; Title: Disposition; Pick-List: FD Transport to Emergency Care Facility (ECF) = 1, Non-FD Transport = 2, Non-FD Transport with FD Attendant = 3, Non-Emergency Transfer = 4, Other = O, Not Transported under EMS = N


Section E20

Disposition


Page 416 of 463

REASON FOR CHOOSING DESTINATION

National Element


E20_16

Definition The reason the unit chose to deliver or transfer the patient to the destination XSD Data Type xs:integer Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) ReasonForChoosingDestination Accepts Null Yes

Field Values -25 -10 4990 5000 5010 5020 5030 5040

Not Applicable Not Known Closest Facility (none below) Family Choice Law Enforcement Choice Other Patient's Physicians Choice Specialty Resource Center

-15 -5 4995 5005 5015 5025 5035

Not Reporting Not Available Diversion Insurance Status On-Line Medical Direction Patient Choice Protocol

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted based on the destination choice ● Allows data to give a reason for choosing the patient’s destination which is important to document from a specialty care agency and diversion/overcrowding perspective



Common Null Values



Destination Determination

State Regulation ● Nebraska EMS Regulation 19 ● Nebraska Trauma Regulation 4.B

Section E20

Disposition


Page 422 of 463

TYPE OF DESTINATION

National Element


E20_17

Definition The type of destination the patient was delivered or transferred to XSD Data Type xs:integer Multiple Entry Configuration No Required in XSD Yes

XSD Domain (Simple Type) TypeOfDestination Accepts Null Yes

Field Values -25 -10 7270 7290 7320 7340 7360

Not Applicable Not Known Home Medical Office/Clinic Nursing Home Other EMS Responder (air) Police/Jail

-15 -5 7280 7300 7330 7350

Not Reporting Not Available Hospital Morgue Other Other EMS Responder (ground)

Uses ● A component of the EMS Medical Record: Patient Care Report ● Allows data to be sorted or grouped based on the EMS transports destination type ● Allows data to describe EMS patient’s destination type


Other Associated Elements E00 Common Null Values E20_01 Destination/Transferred To, Name



Destination/Transferred To

State Regulation ● Nebraska EMS Regulation 19 ● Nebraska Trauma Regulation 4.B

Section E20

Disposition


Page 423 of 463

Section E21

Medical Device Data

Section E21

Medical Device Data


Page 424 of 463

EVENT DATE/TIME E21_01 Data Format [date/time] Definition The time of the event recorded by the device’s internal clock XSD Data Type xs:dateTime XSD Domain (Simple Type) DateTime Multiple Entry Configuration Yes, via structure Accepts Null Yes, but null value is blank or empty Required in XSD No Minimum Constraint 1990 Maximum Constraint 2030 XSD Structure: (1) Each element is section E21 is associated with a E21_01 Date/Time.


Additional Information ● Depending on whether this is a Procedure or a Vital Sign, this can be merged into Date/Time Vital Taken (E14_01) or Date/Time Procedure Performed Successfully (E19_01) ● If the date/time is electronically stored within a database or transmitted via XML as a “tick”, the referenced variables may also be used ● Multiple entry configuration associated with the entire Medical Device Section (E21) to allow multiple sets of device data to be entered


Data Collector ● Medical device and electronically transmitted to the EMS database for further use



Section E21

Medical Device Data


Page 425 of 463

AED, PACING, OR CO2 MODE E21_05 Data Format [text] Definition The mode of operation the device is operating in during the defibrillation, pacing, or rhythm analysis by the device (if appropriate for the event) XSD Data Type xs:integer XSD Domain (Simple Type) AEDPacingOrCO2Mode Multiple Entry Configuration Yes, via structure Accepts Null No Required in XSD No XSD Structure: (1) Each element is section E21 is associated with a E21_01 Date/Time.

Field Values 5210 5220 5230 5240

Automated Advisory Sensing Side-Stream

5215 Manual 5225 Demand 5235 Mid-Stream

Additional Information ● Associated with Event Date/Time (E21_01) and only if appropriate for the Medical Device Event (E21_02)



Other Associated Elements E01_01 Patient Care Report Number E21_02 Medical Device Event Name

E21_01 Event Date/Time


Section E21

Medical Device Data


Page 429 of 463

TYPE OF SHOCK E21_08 Data Format [text] Definition The energy form used by the device for the defibrillation (if appropriate for the event) XSD Data Type xs:integer XSD Domain (Simple Type) TypeOfShock Multiple Entry Configuration Yes, via structure Accepts Null No Required in XSD No XSD Structure: (1) Each element is section E21 is associated with a E21_01 Date/Time.

Field Values 5310 Biphasic

5311 Monophasic







Section E21

Medical Device Data


Page 432 of 463

SHOCK OR PACING ENERGY E21_09 Data Format [number] Definition The energy used for the shock or pacing event (if appropriate for the event) XSD Data Type xs:decimal XSD Domain (Simple Type) ShockOrPacingEnergy Multiple Entry Configuration Yes, via structure Accepts Null No Required in XSD No Minimum Constraint 1 Maximum Constraint 9000 XSD Structure: (1) Each element is section E21 is associated with a E21_01 Date/Time.








Section E21

Medical Device Data


Page 433 of 463

TOTAL NUMBER OF SHOCKS DELIVERED E21_10 Data Format [number] Definition The number of times the patient was defibrillated, if the patient was defibrillated during the patient encounter. XSD Data Type xs:integer XSD Domain (Simple Type) TotalNumberOfShocks Multiple Entry Configuration Yes, via structure Accepts Null No Required in XSD No Minimum Constraint 1 Maximum Constraint 100 XSD Structure: (1) Each element is section E21 is associated with a E21_01 Date/Time.







Section E21

Medical Device Data


Page 434 of 463

PACING RATE E21_11 Data Format [number] Definition The rate the device was calibrated to pace during the event, if appropriate. XSD Data Type xs:integer XSD Domain (Simple Type) PacingRate Multiple Entry Configuration Yes, via structure Accepts Null No Required in XSD No Minimum Constraint 1 Maximum Constraint 1000 XSD Structure: (1) Each element is section E21 is associated with a E21_01 Date/Time.








Section E21

Medical Device Data


Page 435 of 463

Index Data Element 911 Call Volume per Year Abdomen Left Lower Assessment Abdomen Left Upper Assessment Abdomen Right Lower Assessment Abdomen Right Upper Assessment Advanced Directives AED, Pacing, or CO2 Mode Age Age Units Agency Contact Address Agency Contact City Agency Contact Email Address Agency Contact Fax Number Agency Contact First Name Agency Contact Last Name Agency Contact Middle Name/Initial Agency Contact State Agency Contact Telephone Number Agency Contact Web Address Agency Contact Zip Code Agency Medical Director Address Agency Medical Director City Agency Medical Director Email Address Agency Medical Director Fax Number Agency Medical Director First Name Agency Medical Director Last Name Agency Medical Director Middle Name/Initial Agency Medical Director State Agency Medical Director Telephone Number Agency Medical Director Zip Code Agency Medical Director's Medical Specialty Airbag Deployment Alcohol/Drug Use Indicators Annual Vehicle Hours Annual Vehicle Miles Any Return of Spontaneous Circulation APGAR Area of the Vehicle impacted by the collision Arrest Witnessed by Arrived at Patient Date/Time Back Cervical Assessment Back Lumbar/Sacral Assessment Back Thoracic Assessment Barriers to Patient Care Beginning Odometer Reading of Responding Vehicle Billing Status Blood Glucose Level Broselow/Luten Color Carbon Dioxide Cardiac Arrest Cardiac Arrest Etiology Cardiac Rhythm Cardiac Rhythm on Arrival at Destination Cause of Injury Certificate of Medical Necessity Chest/Lungs Assessment

Number D01_14 E16_10 E16_09 E16_12 E16_11 E12_07 E21_05 E06_14 E06_15 D02_04 D02_05 D02_10 D02_09 D02_03 D02_01 D02_02 D02_06 D02_08 D02_11 D02_07 D03_04 D03_05 D03_11 D03_09 D03_03 D03_01 D03_02

Page 15 362 361 364 363 295 429 185 186 27 28 33 32 26 24 25 29 31 34 30 39 40 46 44 38 36 37

D03_06 D03_08

41 43

D03_07 D03_10

42 45

E10_09 E12_19 D06_09 D06_10 E11_06 E14_26 E10_05

274 307 85 86 282 337 270

E11_04 E05_07 E16_14 E16_16 E16_15 E12_01 E02_16

280 164 366 368 367 289 144

D04_10 E14_14 E16_02 E14_13 E11_01 E11_02 E14_03 E11_11 E10_01 E07_02 E16_07

59 325 354 324 277 278 314 287 265 193 359

Data Element Chief Complaint Chief Complaint Anatomic Location Chief Complaint Organ System Closest Relative/ Guardian City Closest Relative/ Guardian Phone Number Closest Relative/ Guardian Relationship Closest Relative/ Guardian State Closest Relative/ Guardian Street Address Closest Relative/ Guardian Zip Code Closest Relative/Guardian Last Name CMS Service Level Common Null Values Complaint Reported by Dispatch Condition Code Modifier Condition Code Number Condition of Patient at Destination Crew Member ID Crew Member Level Crew Member Role Current Medication Administration Route Current Medication Dosage Unit Current Medication Dose Current Medications Date Length of Service Documented Date of Birth Date of Personnel's Certification or Licensure for Agency Date/Time Initial Responder Arrived on Scene Date/Time Medication Administered Date/Time of Assessment Date/Time Procedure Performed Successfully Date/Time Resuscitation Discontinued Date/Time Vital Signs Taken DBP (Diastolic Blood Pressure) Destination City Destination Confirmation of Tube Placement Destination County Destination Facility Number Destination GPS Location Destination Medical Record Number Destination State Destination Street Address Destination Type Destination Zip Code Destination Zone Number Destination/Transferred To, Code Destination/Transferred To, Name Device CO2 or etCO2 Device CO2, etCO2, or Invasive Pressure Monitor Units Device Diastolic Blood Pressure Device Heart Rate Device Invasive Pressure Mean Device Manufacturer Device Name or ID Device Pulse Oximetry Device Pulse Rate Device Purchase Date

Number E09_05 E09_11 E09_12 E07_22 E07_25 E07_26 E07_23 E07_21 E07_24 E07_18 E07_34 E00 E03_01 E07_37 E07_35 E20_15 E04_01 E04_03 E04_02 E12_17 E12_16 E12_15 E12_14 D08_20 E06_16 D07_06

Page 251 257 258 213 216 217 214 212 215 209 225 122 150 229 226 421 154 156 155 305 304 303 302 114 187 93

E08_04

234

E18_01 E16_03 E19_01

380 355 392

E11_09 E14_01 E14_05 E20_04 E19_14

285 312 316 410 405

E20_06 D04_14 E20_08 E12_03 E20_05 E20_03 D04_15 E20_07 E20_09 E20_02 E20_01 E21_18 E21_19

412 63 414 291 411 409 64 413 415 408 407 442 443

E21_15 E21_12 E21_20 D09_03 D09_02 E21_17 E21_13 D09_05

439 436 444 118 117 441 437 120

Data Element Device Respiratory Rate Device Serial Number Device Systolic Blood Pressure Dispatch Notified Date/Time Driver's License Number Duration of Chief Complaint Duration of Secondary Complaint ECG Interpretation ECG Lead Electronic Monitor Rate EMD Card Number EMD Performed EMD Vendor Emergency Department Disposition Employment Status Date EMS Agency County EMS Agency Daylight Savings Time Use EMS Agency Name EMS Agency Number EMS Agency Number EMS Agency State EMS Agency Time Zone EMS Billable Calls per Year EMS Dispatch Volume per Year EMS Patient Contact Volume per Year EMS Personnel's City of Residence EMS Personnel's Date Of Birth EMS Personnel's Email Address EMS Personnel's Ethnicity EMS Personnel's First Name EMS Personnel's Gender EMS Personnel's Home Telephone EMS Personnel's Last Name EMS Personnel's Mailing Address EMS Personnel's Middle Name/Initial EMS Personnel's Race EMS Personnel's State EMS Personnel's Work Telephone EMS Personnel's Zip Code EMS Transport Volume per Year EMS Unit (Vehicle) Response Number EMS Unit Call Sign EMS Unit Call Sign (Radio Number) EMS Unit/Vehicle Number Ending Odometer Reading of Responding Vehicle Environmental/Food Allergies Estimated Body Weight Estimated Date/Time Initial Responder Arrived on Scene Estimated Time of Arrest Prior to EMS Arrival Ethnicity Event Date/Time Extremities-Left Lower Assessment Extremities-Left Upper Assessment Extremities-Right Lower Assessment Extremities-Right Upper Assessment Eyes-Left Assessment Eyes-Right Assessment Fire Incident Report Number

Number E21_16 D09_01 E21_14 E05_03 E06_19 E09_06 E09_09 E21_07 E21_06 E14_08 E03_03 E03_02 D04_17 E22_01 D07_04 D01_04 D01_20 D01_02 D01_01 E02_01 D01_03 D01_19 D01_18 D01_15 D01_17 D08_05 D08_11 D08_10 D08_14 D08_03 D08_12 D08_09 D08_01 D08_04 D08_02 D08_13 D08_06 D08_08 D08_07 D01_16 E02_03 D04_02 E02_12 E02_11 E02_19

Page 440 116 438 160 190 252 255 431 430 319 152 151 66 446 91 5 21 3 2 129 4 20 19 16 18 99 105 104 108 97 106 103 95 98 96 107 100 102 101 17 131 49 140 139 147

E12_09 E16_01 E08_03

297 353 233

E11_08

284

E06_13 E21_01 E16_20 E16_19 E16_18 E16_17 E16_21 E16_22 E22_05

184 425 372 371 370 369 373 374 450

Data Element First Monitored Rhythm of the Patient First Name First Name of Patient's Primary Practitioner First Name of the Closest Relative/ Guardian First Name of the Insured Gender Glasgow Coma Score-Eye Glasgow Coma Score-Motor Glasgow Coma Score-Qualifier Glasgow Coma Score-Verbal GU Assessment Head/Face Assessment Heart Assessment Height of Fall Hospital Disposition Hospital Facility Number Hospitals Served How Patient Was Moved to Ambulance How Patient Was Transported From Ambulance ICD-9 Code for the Condition Code Number Immunization Date Immunization History Incident Address Incident City Incident County Incident Facility Code Incident Location Type Incident Number Incident or Onset Date/Time Incident State Incident ZIP Code Incident/Patient Disposition Initial State Certification Date Insurance Companies Used Insurance Company Address Insurance Company Billing Priority Insurance Company City Insurance Company ID/Name Insurance Company State Insurance Company Zip Code Insurance Group ID/Name Insurance Policy ID Number Intent of the Injury Last Name Last Name of Patient's Primary Practitioner Last Name of the Insured Law Enforcement/Crash Report Number Level of Responsiveness Level of Service Mass Casualty Incident Mechanism of Injury Medical Device Event Name Medical History Obtained From Medical/Surgical History Medication Administered Prior to this Units EMS Care Medication Administered Route Medication Allergies

Number E11_05 E06_02 E12_04 E07_19

Page 281 173 292 210

E07_12 E06_11 E14_15 E14_17 E14_18 E14_16 E16_13 E16_05 E16_08 E10_10 E22_02 D04_12 D04_11 E20_11 E20_13

203 182 326 328 329 327 365 357 360 275 447 61 60 417 419

E07_36

228

E12_13 E12_12 E08_11 E08_12 E08_13 E08_08 E08_07 E02_02 E05_01 E08_14 E08_15 E20_10 D08_18 D04_16 E07_05 E07_04 E07_06 E07_03 E07_07 E07_08 E07_09 E07_10 E10_02 E06_01 E12_06 E07_11 E22_03 E14_22 D01_07 E08_06 E10_03 E21_02 E12_11 E12_10 E18_02

301 300 241 242 243 238 237 130 158 244 245 416 112 65 196 195 197 194 198 199 200 201 267 172 294 202 448 333 8 236 268 426 299 298 381

E18_04 E12_08

383 296

Data Element Medication Authorization Medication Authorizing Physician Medication Complication Medication Crew Member ID Medication Dosage Medication Dosage Units Medication Given Medications Given Mental Status Assessment Method of Blood Pressure Measurement Middle Initial/Name Middle Initial/Name of the Closest Relative/ Guardian Middle Initial/Name of the Insured Middle Name of Patient's Primary Practitioner Model Number National Provider Identifier National Registry Credentialed Neck Assessment Neurological Assessment Neurological Outcome at Hospital Discharge NHTSA Injury Matrix Abdomen NHTSA Injury Matrix External/Skin NHTSA Injury Matrix Face NHTSA Injury Matrix Head NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Neck NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Spine NHTSA Injury Matrix Thorax NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Upper Extremities Number Of Each Personnel Level on the Vehicle Crew Number of Patients at Scene Number of Procedure Attempts Obtained Prior to this Units EMS Care On-Scene Odometer Reading of Responding Vehicle Organization Status Organizational Type Other Agencies In Area Other Associated Symptoms Other Destinations Other EMS Agencies at Scene Other Services at Scene Other Types of Service Outcome of the Prior Aid Pacing Rate Pain Scale Patient Arrived at Destination Date/Time Patient Care Report Number Patient Destination Odometer Reading of Responding Vehicle Patient ID Band/Tag Number Patient’s Employer’s City Patient’s Employer’s State Patient’s Employer’s Zip Code Patient’s Home Country

Number E18_10 E18_11 E18_08 E18_09 E18_05 E18_06 E18_03 D04_06 E16_23 E14_06 E06_03 E07_20

Page 389 390 387 388 384 385 382 54 375 317 174 211

E07_13 E12_05

204 293

D09_04 D01_21 D08_16 E16_06 E16_24 E11_07

119 22 110 358 376 283

E15_06 E15_01 E15_03 E15_02 E15_10 E15_04 E15_09 E15_07 E15_05 E15_11 E15_08 D06_05

346 341 343 342 350 344 349 347 345 351 348 81

E08_05 E19_05 E14_02 E02_17

235 396 313 145

D01_09 D01_08 D01_11 E09_14 D04_13 E08_01 E08_02 D01_06 E09_03 E21_11 E14_23 E05_10 E01_01 E02_18

10 9 12 260 62 231 232 7 249 435 334 167 124 146

E22_06 E07_29 E07_30 E07_31 E06_09

451 220 221 222 180

Data Element Patient’s Occupation Patient’s Occupational Industry Patient's Employer Patient's Employer's Address Patient's Home Address Patient's Home City Patient's Home County Patient's Home State Patient's Home Zip Code Patient's Work Telephone Number Pediatric Trauma Score Personal Protective Equipment Used Personnel Exposed Personnel Level Permitted to Use the Medication Personnel Level Permitted to Use the Procedure Personnel Level Permitted to Use the Protocol Personnel's Agency ID Number Personnel's Employment Status Personnel's Level of Certification/Licensure for Agency Position of Patient During Transport Position of Patient in the Seat of the Vehicle Possible Injury Potential Registry Candidate Pregnancy Presence of Emergency Information Form Primary Method of Payment Primary or Home Telephone Number Primary Role of the Unit Primary Symptom Primary Type of Service Prior Aid Prior Aid Performed by Procedure Procedure Authorization Procedure Authorizing Physician Procedure Complication Procedure Crew Members ID Procedure Performed Prior to this Units EMS Care Procedure Successful Procedures Protocol Protocols Used Provider’s Secondary Impression Providers Primary Impression PSAP Call Date/Time Pulse Oximetry Pulse Rate Pulse Rhyth Race Reason CPR Discontinued Reason for Choosing Destination Relationship to the Insured Required Reportable Conditions Research Survey Field Research Survey Field Title Respiratory Effort

Number E07_17 E07_16 E07_27 E07_28 E06_04 E06_05 E06_06 E06_07 E06_08 E07_32 E14_28 E23_03 E23_07 D04_07

Page 208 207 218 219 175 176 177 178 179 223 339 455 459 55

D04_05

53

D04_09

58

D07_01 D07_03 D07_05

88 90 92

E20_12 E10_07 E09_04 E23_02 E12_20 E12_18 E07_01 E06_17 E02_05 E09_13 D01_05 E09_01 E09_02 E19_03 E19_10 E19_11 E19_07 E19_09 E19_02

418 272 250 454 308 306 192 188 133 259 6 247 248 394 401 402 398 400 393

E19_06 D04_04 D04_08 E17_01 E09_16 E09_15 E05_02 E14_09 E14_07 E14_10 E06_12 E11_10 E20_16 E07_14 E23_08 E23_09 E23_11 E14_12

397 51 56 378 263 261 159 320 318 321 183 286 422 205 460 461 463 323

Data Element Respiratory Rate Response Mode to Scene Response to Medication Response to Procedure Response Urgency Resuscitation Attempted Review Requested Revised Trauma Score Run Report Narrative SBP (Systolic Blood Pressure) Scene GPS Location Scene Zone Number Seat Row Location of Patient in Vehicle Secondary Complaint Narrative Sending Facility Medical Record Number Shock or Pacing Energy Size of Procedure Equipment Skin Assessment Social Security Number Software Creator Software Name Software Version State Certification Licensure Levels State Certification/Licensure Levels State EMS Certification Licensure Level State EMS Current Certification Date State Issuing Driver's License State/Licensure ID Number Station Address Station City Station GPS Station Name Station Number Station State Station Telephone Number Station Zip Station Zone Statistical Year Stroke Scale Successful IV Site Suspected Contact with Blood/Body Fluids of EMS Injury or Death Suspected Intentional, or Unintentional Disaster Temperature Temperature Method Thrombolytic Screen Time Units of Duration of Chief Complaint Time Units of Duration of Secondary Complaint Total Glasgow Coma Score Total Length of Service Total Number of Shocks Delivered Total Service Area Population Total Service Size Area Transfer of Patient Care Date/Time Transport Mode from Scene Trauma Registry ID Tube Confirmation Type of Destination Type of Dispatch Delay

Number E14_11 E02_20 E18_07 E19_08 E07_33 E11_03 E23_01 E14_27 E13_01 E14_04 E08_10 E08_09 E10_06 E09_08 E12_02 E21_09 E19_04 E16_04 E06_10 E01_02 E01_03 E01_04 D04_01 D06_04 D08_15 D08_17 E06_18 D07_02 D05_05 D05_06 D05_04 D05_01 D05_02 D05_07 D05_09 D05_08 D05_03 D01_10 E14_24 E19_12 E23_05

Page 322 148 386 399 224 279 453 338 310 315 240 239 271 254 290 433 395 356 181 125 126 127 48 80 109 111 189 89 72 73 71 68 69 74 76 75 70 11 335 403 457

E23_04

456

E14_20 E14_21 E14_25 E09_07 E09_10

331 332 336 253 256

E14_19 D08_19 E21_10 D01_13 D01_12 E05_08 E20_14 E22_04 E19_13 E20_17 E02_06

330 113 434 14 13 165 420 449 404 423 134

Data Element Type of Response Delay Type of Scene Delay Type of Service Requested Type of Shock Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Transport Delay Type of Turn-Around Delay Unit Arrived on Scene Date/Time Unit Back at Home Location Date/Time Unit Back in Service Date/Time Unit Cancelled Date/Time Unit En Route Date/Time Unit Left Scene Date/Time Unit Notified by Dispatch Date/Time Unit/Vehicle Number Use of Occupant Safety Equipment Vehicle Dispatch GPS Location Vehicle Dispatch Location Vehicle Dispatch Zone Vehicle Initial Cost Vehicle Model Year Vehicle Type Vehicular Injury Indicators Waveform Graphic Waveform Graphic Type Who Generated this Report? Work-Related Year Miles/Hours Accrued Zones

Number E02_07 E02_08 E02_04 E21_08 E23_06

Page 135 136 132 432 458

E02_09 E02_10 E05_06 E05_13 E05_11 E05_12 E05_05 E05_09 E05_04 D06_01 E10_08 E02_15 E02_13 E02_14 D06_06 D06_07 D06_03 E10_04 E21_04 E21_03 E23_10 E07_15 D06_08 D04_03

137 138 163 170 168 169 162 166 161 78 273 143 141 142 82 83 79 269 428 427 462 206 84 50

Appendix A: State of Nebraska Regulations: Emergency Medical Services (Title 172 NAC 12) EFFECTIVE October 26, 2003

NEBRASKA HEALTH AND HUMAN SERVICES REGULATION AND LICENSURE 172 NAC 12

12-003.04I Records Maintenance Standards: Each emergency medical service must maintain records as outlined below: 1. Emergency medical services must maintain current personnel rosters and personnel files on each out-of-hospital emergency care provider for their service. All records must be maintained until superseded. Each file must include, but not be limited to, the following: a. Name, address, and telephone number; b. Current level of certification; and c. Current cardiopulmonary resuscitation certification. 2. Other current certifications/endorsements as may be required by the physician medical director; and 3. Documentation of each out-of-hospital emergency care providers emergency medical continuing education training, as defined in 172 NAC 11-002, that includes: a. Name of the course taken; b. Date of the course; c. Name of the instructors of the course; and d. Number of hours of training for each course taken. 4. Copies of renewal documentation from the physician medical director or surrogate which verifies personnel competency. 12-003.04J Vehicle Records: Emergency medical services must maintain records of vehicle and equipment maintenance and repair for not less than five years. 12-003.04K Patient Care Records: Emergency medical services must complete a patient care record for each response that the service makes. 12-003.04K1 The following information, as a minimum, must be recorded for each patient transported: 1. The name, age, and sex of the patient(s); 2. The address or location from which the patient(s) is taken; 3. The date of the call; 4. The time of dispatch and the time the ambulance is en route to the call; 5. The time of arrival at the scene; 6. A record of the chief complaint of the patient and/or the signs and symptoms of the patient; 7. A record of the patient(s) vital signs and the times at which these were noted; 8. A brief patient history; 9. A description of the treatment provided and equipment used; 10. A record of the time of each electrotherapy attempt and the results of each administration; 11. The name of the receiving facility or location; 12. The name or code number of the individual providing the primary care for the patient; and 13. A record of any care provided to the patient prior to the arrival of the out of hospital personnel; 14. Location type; 15. Time unit left scene; 16. Time arrival at destination; 17. Time back in service; 18. Race/ethnicity of the patient; 19 Destination determination; 20. No patient treatment/no patient transportation;

21. Factors affecting EMS delivery; 22. Time CPR discontinued; 23. Adult/pediatric Glascow coma scale; and 24. Trauma score. 25. A record of the time, dosage, and route of epi-auto injections and aspirin administered; and 26. A record of the time, rate, type and delivery location of intravenous fluids administered. 12-003.04K2 A record of dry runs, refused transportation, and stand by services must be maintained. 12-003.04K3 The Department must make available a form that will meet the patient record keeping requirements of these regulations. 12-003.04K4 All patient care and run information records must be maintained for not less than five years. Patient medical care and run information must be sent to the Department quarterly, within 30 days after the end of each quarter, for inspection and use for data collection and research. Patient care and run information may be sent either in paper form or by electronic media. This requirement does not supersede any medical or legal requirements for maintenance of patient records. 12-003.04K5 No patient data received or recorded will be divulged, made public or released by an emergency medical service or out-of-hospital emergency care provider, except that the patient data may be released to the receiving health care facility, to the Department for statistical purposes, or to anyone to whom the patient who is the subject of the record has given written authorization.

Appendix B: State of Nebraska Regulations: Nebraska Statewide Trauma System (Title 185 Nebraska Administrative Code) EFFECTIVE MARCH 10, 2002

NEBRASKA HEALTH AND HUMAN SERVICES REGULATION AND LICENSURE 185 NAC 9

The trauma registry concerning every patient who meets the following criteria: 1. Had at least one of the following ICD-9-CM diagnosis codes: Injury codes in the range of 800-959.9, 994.1 (drowning), 994.7 (asphyxiation & strangulation) or 994.8 (electrocution). 2. Had trauma injuries and was admitted to the hospital from the emergency department. 3. Had trauma injuries and was transferred out of the hospital. 4. Had trauma injuries and was admitted directly to the hospital, bypassing the emergency department. 5. Had trauma injuries and died in the emergency department. 6. Had trauma injuries and was dead on arrival in the emergency department.

9-009 The report must contain the following information: 1. Regarding the patient: a. b. c. d. e. f. g. h.

2. 3.

Insurance category (Hospital) Regarding the injury: a. b. c. d. e. f. g.

4.

Name (EMS and Hospital) Social security number (Hospital, if available) Sex (EMS and Hospital) Race (EMS and Hospital) Age (EMS and Hospital) Date of birth (Hospital) Address (Hospital) Zip code (Hospital)

Date (EMS) Time (EMS) Zip code (EMS) E-Code (Hospital) Mechanism of injury (EMS) Location category (EMS) Safety device (EMS)

Regarding out-of-hospital activity: a. b. c. d. e.

EMS run number (EMS) Destination determination (EMS) Dispatch time (EMS) Time of arrival at scene (EMS) Transport time:

1. 2. f.

Time left scene (EMS) Time arrived at facility (EMS)

Initial patient data:

1.

Blood pressure (EMS)

EFFECTIVE NEBRASKA HEALTH AND HUMAN SERVICES MARCH 10, 2002 REGULATION AND LICENSURE

5.

2. Pulse 3. Respiration (EMS) 4. Glasgow coma score, or Pediatric coma scale (EMS and Hospital) 5. Trauma score, or Pediatric trauma score (EMS and Hospital) 6. Airway management (EMS) Regarding the sending hospital: a. b.

6.

Name Arrival and transfer:

1. Date 2. Time 3. Patient data, as listed in 4f 4. Temperature 5. Destination Determination Regarding the sending hospital: a. b.

Name Arrival and transfer:

1. 2. 3. 4. c. d.

e. f.

Amphetamines Barbiturates Benzodiazepine Tricyclic Cocaine Methamphetamines PCP Poly drug Antidepressants

Blood alcohol level if performed Airway management:

1. 2. 3. 4. 5. g.

Date Time Patient data, as listed in 4f Temperature

Admitting service Drug screen results if performed:

1. 2. 3. 4. 5. 1. 2. 8. 9.

Bag valve mask Oral intubation Nasal intubation Cricothyotomy Tracheotomy

Disposition from ED:

1.Within the hospital: a. Intensive care unit b. Burn center c. Labor and delivery d. Operating room e. Floor 2.From hospital: a. Transfer b. Died in ED c. Dead on arrival at the ED

EFFECTIVE

185 NAC 9

NEBRASKA HEALTH AND HUMAN SERVICES

MARCH 10, 2002 h.

REGULATION AND LICENSURE

185 NAC 9

Disposition from the hospital:

1. Home 2. Home Health 3. Nursing home 4. Jail 5. Died in hospital 6. Transferred to: a. Mental health facility b. Burn center c. Rehabilitation i. j. k. l. m. n. o. p. q. r.

7.

Length of stay ICU days Unplanned readmission Heat CT results ICD-9-CM diagnosis codes ICD-9-CM procedure codes Injury severity codes Probability of survival Complications from American College of Surgeons list Functional independence measure of discharge (FIM score) - abbreviated

Regarding the rehabilitation center: a. b.

Length of stay Disposition from the hospital:

1. Home 2. Hospital 3. Home health 4. Skilled nursing home 5. Jail 6. Died in hospital 7. Transferred to: a. Mental health facility b. Burn center c. Higher level rehabilitation center c. d. e.

ASIA (American Spinal Injury Association) score Comprehensive FIM score (excluding Basic and General B centers) Rancho (For Acquired Traumatic Brain Injuries score)