national ems database

National EMS Database

Greg Mears, MD FACEP

Principal Investigator

North Carolina EMS Medical Director

University of North Carolina-Chapel Hill

The Project:National EMS Information System

Long Term Goals

Electronic EMS Data Standard EMS

Dataset Data Systems

Local State National EMS

Database Data Drives EMS

System Personnel Clinical Care

EMSResponse

Event Recognition/Action

At Scene

PSAP NotificationPre-Event

Response

Call Dispatch

Call Process At Patient

EMS Performance Improvement Resource CenterEMS Response by Chronology

Staffing

Planning

Community

Readiness

Community

Definition/Acuity

Event Type

Size/Volume

Environment

PublicKnowledge

HealthcareInterface

Environment

Special Needs/Cultural Barriers

First Aid

InitialRing/Answer

Personnel/Staffing

Automated Action/Process or Decision Algorhythm

EMD

Address

Environment

Community

Access

Safety

12/09/2004

Deployment/Capability

Configuration

Deployment Plan

Demand vs. Supply

Geography

System Status Plan

TieredResponse

Information System

Scheduling

Personnel Level

Availability(Time)

Utilization

Numbers

SystemUnderstanding

Buy in

Motivation/Commitment

FatigueSatisfaction

CompensationCulture

Policy andProcedure

Pre-PlanAnalysis

ReconfiguratiionPerformanceImprovement

Future Planning Exercise/Training

Expectations

Socio-EconomicTax base/funding

Geography/Density

Knowledge/Education

People Ready

Public Perception

SystemKnowledge

Cultural/ReligiousIssues

Medical ExperienceKnowledge

History

CommunityEducation Public

Education

MotivationFear/

ResponsibilityLiability

Nursing Homes

Social Services

Community Center

Non-HealthcareFacilities

Auto-Notification

Lifeline

Other Schools

Mutual Aid

Healthcare Facilities

Perceived Value

Experience

Environment

Technology

Transport

Weather

Gated Communities,

etc.

SeasonalVariations

Infrastructure

Roads

Weather

Location

Boundaries/Access

Public/Private

Vehicle ReadyEquipment Ready

Geography/Topography

Cultural/Religious

Demographics

Alcohol/Drugs

Location

Public Education EducationalLevel

MedicalHistory

Medicalvs.

Trauma

Transport OnlyAccidental

vs.Intentional

Public Healthvs.

Healthcare

Singlevs.

Mass Casualty

Adultvs.

Pediatric

Naturalvs.

Man Made

WeaponsOf

Mass Destruction

Scene/Incident Size Patient Numbers

EventNumbers

Weather

Seasonal

Access

Geography

Safety

Locating the Event

Physician Offices

DayOp CentersFree Standing ED’s

Other

PoisonControl

Weather

Witnesses/Bystanders Geographic

Location

Safety

Capability

PhoneAccess

Knowledge

Motivation

CorrectActivation

Language

Religeon

Tradition

Race/Ethnicity

Impairment SpecialNeeds

Fear Empowerment/Custody

CPR

PAD

First Aid AEDOther

Equipment

FormalNon-EMS Response

Education Fear/Motivation

Personal Safety

Patient Safety

Incident Security

Bystander Safety

Communication

AlternativeCommunication

Level of Information

MultipleNotifications

Functioning Phone

Access

Non-Verbal

LanguageBarriers

Walk-In

Drive By

Lifeline AlarmsTelematics

Proximity

Caller

Knowledge

LocationAwarenessPrimary

SecondaryTertiary

ConfidentialityLanguage Barriers

ReceiverPerformance

Multiple Rings/Hold

EventConfusion

OrderTriage

Accuracy

TimeOf

DayStaffing

ResourceAllocations

Location

Event Location ID

Unknown LocationKnowledgeOf Access

AwarenessIdentifiers

Locators

InaccurateInformation Dispatch Error

Location of Callvs.Location of Scene

Distractions/Other Responsibilities Disaster Mode

Language

Delay Volume

Staffing

MotivationHardware

Software

Relays-Levels

Language

Repetition-Time DelayCaller Frustration/

Cooperation

Coordination Handoffs

Drops

TrainingMisinformation

SeeInitial Ring/Answer

Above

Training

Scheduling

Motivation

Personal Relations Satisfaction

WorkEnvironment

Location ID

Cell Communications/Location

PolicedBoundaries

Technology

GIS Capabilities

Training

Interoperability

Manualvs.

Computer

Telematics

Decision Automation

Protocol Policy

Documentation

Education PerformanceImprovement

Recall/Review

Politics

Yes/No

Application

QualityManagement Performance

Improvement

ImplementationPersonnelEducation

Cardsvs.

Computer

Technology(Method)

Fail Safe

Capacity or Backlog

Confirmation

See Call ProcessingInitial Ring-Answer

AndRelays-Levels

Mode Selection

Inter-operability/CoordinationDecision Point

(Send)

Contingency Plan

Business Plan Hardware Back

Redundant Notification Exercise/Training

Volume

EquipmentPeople

(Staffing)Vehicle

Availability

Airtime

Acknowledgement

Status Change

Personnel

CommunicationExchange

Personnel

Equipment/Technology

Navigation

Location(Scene)

Environment

Policy/Procedure

Truck In Motion

Safety

Confirmation

Routing

PatientInformation

Directions

Clarity

LocationAccuracy inReporting

HomeActivity Level

Physiologic

StationTime of Day

Fatigue

AVCTrafficControlSystems

Functional VehicleAnd Equipment

MappingKnowledge

Map BookTime Based Events

TrafficRoads

WeatherTrain

Restricted Access Gated Communities

WeatherHazmatIncident Crowd

Time Limits Protocol

Black Box Verbal Response

UnableTo

LocateNot

MarkedNot

Mapped

Weather Hazmat Crowd

Geography

Public Response/Aid

Demographics

Alcohol/Drugs

Gated Roads Restricted Access

Patient Personnel

PatientCooperation

Mass Care

Rescue/Access

Safety

Cultural

Location

Environment

Geography

Access WildernessVertical

CrowdWeather Hazmat

UnknownAccess

EntrapmentIsolated

Language

Ethnic

Religeon

Family

Patient Personnel

Multiple TypesHigh Angle

Swift WaterOthers

NumberOf

Patients

Resources

Power

Water Density

Decontamination

ControlLaw

Enforcement

Communications

Alcohol/Drugs Special

Needs Fear

Ethnicity

Language

The Team NASEMSD

Project Management Regional Meetings Operational Support

Greg Mears, MD Principle Investigator

NEDARC Clay Mann, PhD, Co-Investigator Mike Dean, MD, Co-Investigator Technical Assistance

State Data-Managers

The Money

NHTSA EMS Division (Primary)

HRSA Trauma and EMS EMS-C

American Heart Association Support for EMS Software Development

The ConsensusProfessional Organizations

AAA AAMS ACEP ACS-COT (NTDB) AHA (NRCPR) EMSOP IAFC IAFF NAEMD NAEMSP NASEMSD NENA

Federal Partners

CDC FEMA HRSA-EMSC HRSA-EMSC/NEDARC HRSA-EMSC/NRC HRSA-ORHP HRSA-Trauma/EMS NHTSA

The National EMS Information System

Local System

State

National

The Data Sources

Linkage

MedicalDevice

DomesticTerrorism

Outcomes

QualityManage-

mentPersonnel

System

CardiacArrest

Trauma

Patient

Incident

Dispatch

NHTSA2.0

The Truth about NEMSISMacroscopic Public education and

drive policy Identify national trends Drive education Prioritize needs and

funding Benchmarking Solidify EMS in the

Healthcare family

Microscopic Outcomes EMS Research

hypothesis Promote research

Reality Business structure and

management Improve reliability and

efficiency Reduce errors Determine effectiveness of

systems and patient care

The Need EMS Education

Curriculums Local Education

EMS Outcomes Something other than death System evaluation

EMS Research Generate hypothesis Evaluate Cost effectiveness Identify problems and target issues

EMS Reimbursement National fee schedule and reimbursement rates

GAOEmergency Medical Services

Reported Needs Are Wide-Ranging, With a Growing Focus on Lack of Data

GAO Results…..

The extent and impact of the reported needs is difficult to ascertain, however, because there is little standard and quantifiable information that can be used across systems. Most of the available information about the effect of unmet needs is localized and anecdotal.

Local Pulse

Data collection is important Medical record keeping Local data analysis Decision making Do not detract from patient care Short time frame of documentation

Local: Where we are

Very little information on local EMS data collection

Most systems are paper based but are discussing or transitioning to electronic

Many systems use paper and scan into databases or do manual entry

Local: Where we are

Few systems are compliant with the NHTSA dataset definitions

Several models for data collection, but no uniformity or consistency across systems

In general, there is an absence of data to drive reimbursement and policy decisions

Local: Where we want to be

Electronic data collection Uniform dataset with

definitions Patient care Technician System

Workflow oriented No dual entry Data comes from the source

CAD Medical Devices

The health care components are linked Hospital Dispatch Public Health Public Safety

Quality Improvement Benchmarking Community based Information is passed to the

State office of EMS for finance and policy decisions

Local: How to get there Technical Assistance Model administrative and/or statutory

language Standards for data collection and definitions Attach to EMS Education Agenda and local

training programs National job description for EMS providers Medical and communication device

transmission standards National Performance Standards

State Pulse

There is no data for: Resource planning Budget justification System-wide

evaluation Injury prevention

programs Target support and

assistance

State: Where we want to be

State EMS database on every EMS patient encounter

Electronic data transmission Privacy and confidentiality protection

System and patient

Statutory authority

State: Where we want to be

System wide Quality Improvement Benchmarking of compliance and public

health indicators Disaster Management Bioterrorism Surveillance Support and Assistance Resources Annual Report for policy makers Provide data to the National EMS Database

State: How to get there

Identify resources for a state EMS database Technical Assistance Model templates and database schema’s Model quality improvement reports Support to the state EMS office Uniform Dataset and definitions Peer Review Model Legislation Promote Research

National Pulse

Asystole

National: Where we are

EMS Agenda for the Future Monographs, Trade journals Surveys

National: Where we want to be


NASEMSD lead the charge

Revision of the NHTSA Dataset

Multidisciplinary approach

What will we do with it? Public education and

drive policy Identify national trends Benchmarking Reduce errors Business structure and

management EMS Research

hypothesis Promote research

Outcomes Solidify EMS in the

Healthcare family Drive education Prioritize needs and

funding Determine

effectiveness of systems and patient care

NEMSIS Project

Dataset XML Business Model Pilot Project Outreach/PR Software Development

The ProgressCompleted

NHTSA Version 2 Dataset EMS Demographic

XSD Standard Business Model

In Progress Pilot National EMS

Database Mississippi North Carolina 4 others

Business Logic Record Component Data Element

Database Validity EMS Data Collection

Software

Data Dictionary Name Definition Variable Definitions Single or Multiple Entry Relationship to other

Data Elements Null Values National EMS

Database Element

Data Element Use Medical Record Quality Management

Report Types Possible Collected by Whom Relationship to Other

Datasets NHTSA Version 1 NFIRS Utstein

Data Dictionary: XML Data Type

Integer, String, Date/Time, Number Relationship

One to One Many to One

Required in XML Minimal Entry Constraint Maximal Entry Constraint Formatting

Pilot Project Demonstration


States Participating Minnesota Mississippi North Carolina Others as possible

Timeline May, 2005

Key Components National Dataset XML Physical Database

for Storage Web Based

Reporting to the public

The State of the States

2003 Rural EMS Survey

Collection of Statewide EMS DataStates Territori

es

No and Nothing is Planned 2 (4%) 2 (33%)

No, But a System is Being Planned 6 (12%) 0

No, But a System is Being Developed 9 (18%) 3 (50%)

Yes, <50% of EMS Events are Being Collected 5 (10%) 0

Yes, >50% of EMS Events are Being Collected 20 (40%) 0

Yes, 100% of EMS Events are Being Collected 8 (16%) 1 (17%)

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


Submission of EMS Data to the StateStates Territories

No, No Plan to Require Data 3 (6%) 4 (67%)

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

Yes, Data is Required through Regulation or Law

35 (70%) 1 (17%)

Total States Reporting on EMS Data Submission

50 (100%) 6 (100%)


Authority to Collect Patient IdentifiersStates Territori

es

Yes 38 (76%) 3 (50%)

No 10 (20%) 2 (33%)

Unknown 2 (4%) 1 (17%)

Total States Reporting on EMS Data Identifiers

50 (100%) 6 (100%)


Peer Review ProtectionStates Territories

Yes 23 (46%) 0

No 21 (42%) 2 (33%)

Unknown 6 (12%) 4 (67%)

Total States Reporting on Peer Review Protection

50 (100%) 6 (100%)


2002 EMS Patient TransportsStates Territories

Minimum EMS Patient Transports/state 27,463 4,000

Maximum EMS Patient Transports/state 1,502,000 84,000

Average EMS Patient Transports/state 331,153 54,595

Median EMS Patient Transports/state 130,000 75,785

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

Total States Reporting EMS Patient Transports

21 (42%) 3 (50%)

NEMSIS 2005 - 2006 Limited Implementation of the National EMS Database Establishment of a NEMSIS Resource and Technical

Assistance Center Documentation

Compliance Data Validity Measurement of progress across states

Increased use support and software developer interaction Software

Database schema XML test cases Data entry software Scripted reports

Other?

national ems database

Documents

intentionalpublic healthvs

mass casualtyadultvs