Transcript NEMSIS: The Project and the Center Paige Nielsen, BS NEMSIS Technical Assistance Center.

NEMSIS: The Project
and the Center
Paige Nielsen, BS
NEMSIS Technical Assistance Center
Overview
• Need for standardized data
• NEMSIS
– Two primary objectives for ONE PURPOSE
– Where we are today
• Elements NEMSIS collects related to
Stroke victims
Why is EMS Data Collection
Difficult?
Mark Bess
Antonia Marie Pilaski
Alias:
Toni Pilaski
Antonia Pilaski
Work Address:
Marie Pilaski
24 6 Montgomery Street Salt Lake City, UT
Antonia Marie Pilaski
Address:
Alias:
Trauma Center
Address:33 Prince Regent Street Salt Lake City, UT
Toni
Marie
450 1st Avenue,
Salt
LakeAntonia
City, UTPilaski
Response Address:
9-1-1 call place from
the residence
39 Prince Regent Street Salt Lake City, UT
First Hospital Address:
245 Chipeta Way, Murray, UT
EMS responds to neighbour's house
Marie is transported to nearest hospital
15 hours later, Marie transferred to a trauma center
A domestic dispute with fiancée arrested at work
Who Know’s Marie’s
Story?
Status Among States
W
A
M
T
O
R
N
D
S
D
ID
Marianas
Islands
W
Y
N
V
Guam
M
N
U
T
C
A
C
O
American
Samoa
A
Z
MI
W
I
IA
N
E
I
L
K
S
NM
W
V
KY
NC
TN
A
R
SC
MS
TX
O
H
IN
M
O
OK
ME
V
T N
H
NY
CMAR
T I
PA
N
DJ
E
District of
VA
Columbia
A
L
GA
L
A
AK
FL
Puerto Rico
KEY:
HI
U.S. Virgin
Islands
Active Data System
No Active Data System
Did Not Respond to Survey
Source: NEMSIS TAC
Capability Survey, 2006
The Need
• EMS Education
– Curriculums
– Local Education
• EMS Outcomes
– Something other than death
– System evaluation
• EMS Research
– Generate hypothesis
– Evaluate cost-effectiveness
– Identify problems and target issues
• EMS Reimbursement
– National fee schedule and reimbursement rates
EMS Performance Improvement Resource Center
EMS Response by Chronology
Cultural/
Religious
Geography/
Topography
Event
Recognition/Action
Alcohol/
Drugs Demographics
Community
Education
Community
Knowledge
Pre-Event
Medical
History
Public
Knowledge
Motivation
Utilization
Scheduling
Availability
(Time)
Information System
Seasonal
Gated Variations
Communities,
etc.
Weather
Deployment/
Capability
Configuration
Geography
Deployment Plan
Demand vs. Supply
Transport
Technology Infrastructure
Medical
vs.
Trauma
Staffing
Satisfaction
Culture
Compensation
Single
vs.
Mass Casualty
Analysis
Pre-Plan
Policy and
Procedure
Reconfiguratiion
Performance
Improvement
Planning
Future Planning
Other
Physician Offices
Poison
Control
DayOp Centers
Free Standing ED’s
Healthcare Facilities
Witnesses/
Bystanders
Weather
Weapons
Of
Mass Destruction
Scene/
Incident Size
Tax base/funding
Expectations
Weather
Special
Needs
Geography
Access
Safety
Public Perception
Formal
Non-EMS Response
People Ready
Delay
Volume
Distractions/
Other Responsibilities
Handoffs
Coordination
Software
Language
Disaster Mode
Relays-Levels
Language
Training
See
Initial Ring/Answer
RepetitionAbove
Time Delay
Caller Frustration/
Cooperation
Motivation
Work
Scheduling
Environment
Personnel/
Staffing
Personal Relations
Cell Communications/
Location
GIS Capabilities
Policed
Boundaries
Protocol
Inter-operability/
Coordination
Decision Point
(Send)
Equipment
Application
Exercise/Training
People
(Staffing)
Personnel
Education
Cards
vs.
Computer
Weather
Hazmat
Language
Demographics
Patient
Patient
Multiple Types
High Angle
Swift Water
Restricted Access
Others
Rescue/
Access
Number
Of
Patients
Personnel
Resources
Power
Water
Control
Protocol
Communications
Decontamination
Acknowledgement
Alcohol/
Drugs
Verbal
Response
Personnel
Status Change
Density
Mass Care
Policy/Procedure
Black Box
Family
Personnel
Safety
Roads
Access
Time Limits
Volume
Entrapment
Religeon
Cultural
Public Response/
Aid
Community
Crowd
Crowd
Location
Gated Communities
Hazmat
Incident
EMS
Response
Isolated
Ethnic
Alcohol/
Drugs
Wilderness
Hazmat
Unknown
Crowd
Environment
Map Book
Mapping
Vertical
Environment
Weather
Functional Vehicle
And Equipment
Location of Call
vs.
Location of Scene
Geography
Safety
Politics
Call Process
Not
Mapped
Environment
Vehicle
Availability
Airtime
Implementation
Location
(Scene)
Dispatch Error
Access
Gated
Restricted Access
Hardware Back
Not
Marked
Geography
Time Based Events
Traffic
Roads
Knowledge
Weather
Train
Capacity or Backlog
EMD
Location
Accuracy in
Reporting
Navigation
Redundant Notification
Performance
Improvement
Equipment/
Technology
Technology
(Method)
Decision Automation
Quality
Management
See Call Processing
Initial Ring-Answer
And
Relays-Levels
Activity Level
Time of Day
Fatigue
Traffic
Control
Systems
AVC
Mode Selection
Fail Safe
Automated Action/
Process or Decision Algorhythm
Yes/No
Station
Personnel
Telematics
Knowledge
Of Access
Identifiers
Locators
Access
Unable
To
Locate
Clarity
Time
Of
Day
Awareness
Weather
Home
Technology
Manual
vs.
Computer
Staffing
Unknown Location
Event Location ID
Bystander Safety
Address
Physiologic
Location
Contingency Plan
Satisfaction
Education Performance
Improvement
Documentation
Recall/Review
Communication
Exchange
Interoperability
Training
Resource
Allocations
Order
Triage
Accuracy
Inaccurate
Information
Directions
Patient
Information
Confirmation
Business Plan
Policy
Routing
Location ID
Training
Misinformation
Drops
Fear/
Motivation
Incident Security
Safety
Motivation
Hardware
Staffing
Initial
Ring/Answer
Education
Patient Safety
Personal Safety
Equipment Ready
Knowledge
Multiple
Notifications
First Aid
Location
Vehicle Ready
Multiple Rings/Hold
AED
Other
First Aid
Locating the Event
Readiness
Event
Confusion
Equipment
PAD
Environment
Cultural/Religious
Issues
System
Knowledge
Primary
Secondary
Tertiary
Level of Information
Fear Empowerment/
Custody
CPR
Experience
Location
Awareness
Confidentiality
Receiver
Language Barriers Performance
Community
Knowledge/
Education
Race/
Ethnicity
Alarms
Caller
Proximity
Tradition
Impairment
Seasonal
Telematics
Lifeline
Special Needs/
Cultural Barriers
Event
Numbers
Patient Numbers
Geography/
Density
Geographic
Location
Religeon
Size/
Volume
Perceived Value
Drive By
Walk-In
Alternative
Communication
Environment
Natural
vs.
Man Made
Language
Exercise/Training
Socio-Economic
Adult
vs.
Pediatric
Communication
Mutual Aid
Accidental
vs.
Intentional
Non-Verbal
Functioning Phone
Schools
Other
Healthcare
Interface
Public Health
vs.
Healthcare
Transport Only
Language
Barriers
Access
Lifeline
Community Center
Event Type
Fatigue
PSAP Notification
Liability
Social Services
Public/Private
Buy in
Capability
Fear/
Responsibility
Nursing Homes
Roads
Weather
Motivation/
Commitment
System
Understanding
Numbers
Boundaries/
Access
Environment
System Status Plan
Motivation
Non-Healthcare
Facilities
Auto-Notification
Location
Tiered
Response
Phone
Access
History
Definition/Acuity
Personnel Level
Correct
Activation
Knowledge
Public
Education
Medical Experience
Educational
Level
Public Education
Truck In Motion
Law
Enforcement
Ethnicity
Special
Needs Fear
Patient
Cooperation
Language
Confirmation
At Patient
Safety
At Scene
Call Dispatch
Response
12/09/2004
NEMSIS Purposes
• Compose a Uniform Dataset
– Demographic dataset (EMS System)
– EMS dataset (EMS Event)
• Ensure the Portability of Data
– XML (eXtensible Markup Language )
– XSD (XML Schema Definition)
NEMSIS Overview
Patient Care Report Software
Patient
Care
Report
Agency A’s Software
Patient
Care
Report
911
Center
Agency B’s Software
Patient
Care
Report
Agency C’s Software
Where are we?
States Using the NHTSA Standard
W
A
M
T
O
R
N
D
S
D
ID
Marianas
Islands
W
Y
N
V
Guam
M
N
W
I
U
T
C
A
C
O
A
Z
I
L
K
S
American
Samoa
MI
IA
N
E
NM
W
V
KY
NC
TN
A
R
SC
MS
TX
O
H
IN
M
O
OK
ME
V
T N
H
NY
CMA
R
T I
PA
N
DJ
E
District of
VA
Columbia
A
L
GA
L
A
AK
FL
Puerto Rico
HI
U.S . Virgin
Islands
KEY
100% of
the EMS
Data Dictionary
Uses
Using the NHTSA
2.2 Standard
EMS
Data
Dictionaries
100%
Compliant
with NHTSA
2.2
Not 100%
of the
EMS Data Dictionary
Using
the NHTSA 2.2 Standard
EMS
Data
Dictionaries
not 100%
Compliant
or No Answer
Did Not not
Respond
to Survey
States
Reporting
National EMS Database
W
A
M
T
O
R
N
D
S
D
ID
Marianas
Islands
W
Y
N
V
Guam
M
N
W
I
U
T
C
A
C
O
A
Z
I
L
K
S
American
Samoa
MI
IA
N
E
W
V
KY
NC
TN
A
R
NM
O
H
IN
M
O
OK
ME
V
T N
H
NY
CMA
R
T I
PA
N
D
J
E
District of
VA
Columbia
SC
MS
A
L
GA
L
A
TX
AK
FL
Puerto Rico
HI
U.S . Virgin
Islands
KEY
Submitting in 2006
Reporting as Capable of Submitting in 2007
Reporting a Date After 2007 or Unknown
Did Not Respond to Survey
NEMSIS TAC
• To facilitate the collection of EMS data
from States and Territories to create the
National EMS Database.
– Two campuses
– Ten staff
– NEDARC is offering assistance
– Small grant opportunities
www.nemsis.org
Funds Available !
• Money provided by NHTSA ($255,000)
– Uses:
– To aid states over the hurdle of submitting
data to the National EMS Repository
• Additional programming
• Software modifications
• Needed consensus meetings
• Section 408 funds
Facilitate a Focused Effort
• Strategic Plan built around a one-month
timeline:
– Full dedication of the NEMSIS Team
• Designed to built momentum and relationships
Collected Elements Related to
Stroke Victims
• E03_01: Complaint Reported by Dispatch
– 480 – Fall Victim
– 550 – Unconscious/Fainting
– 535 – Stroke/CVA
• E09_12: Chief Complaint Organ System
– 1355 – CNS/Neuro
– 1385 – Psych
• E09_13: Primary Symptom
– 1415 – Change in responsiveness
– 1460 – Menta/Psych
Collected Elements Related to
Stroke Victims (cont.)
• E09_14:Other Associated Symptoms
– 1415 – Change in responsiveness
– 1460 – Mental/Psych
• E09_15: Providers Primary Impression
– 1730 – Stroke/CVA
• E09_16: Providers Secondary Impression
– 1730 – Stroke/CVA
Collected Elements Related to
Stroke Victims (cont.)
• E23_09: Research Survey Field
– Allows states to add on additional variables
• E23_02: Potential Registry Candidate
– Can be an additional fields for state data
systems to flag patients for specific registries
Conclusion
• The NEMSIS Standard is here to stay
• The efforts of the EMS community (plus
the standards) will improve patient care
• Data collection and evaluation are the first
steps in continuous improvement
T
H
A
N
K
Y
O
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Available Resources
Paige Nielsen
Michael Ely
(801) 581-7373
(801) 585-9761