EMS Patient Care Report Navigation Logic for Record Creation

This document serves to provide specifications regarding data entry and data element completion requirements for PreMIS Version 2 web-based application and for the NEMSIS windows based application. These specifications provide a method to minimize data entry through the use of internal business logic and provide a more work oriented data entry process. The ultimate goal is to create both a user friendly and efficient documentation process. The NHTSA Version 2.2.1 dataset is divided into sections. For data entry purposes, these sections must be divided into screens or windows for orderly data completion. The following table describes the screen contents based on the NHTSA date element sections (E data elements only). Data elements required to generate a NHTSA Version 2.2.1 XML file include the data elements marked as National. Some of these data elements are in the headed or the XML file and must be collected in the initial configuration of the software application prior to software use or data entry. Required Data Elements for Software Configuration: 1. 2. 3. 4. 5. 6. E01_02: Software Creator E01_03: Software Name E01_04: Software Version E02_01: EMS Agency Number Billing: Yes/No (This is not a NHTSA Version 2.2.1 data element but indicated whether to include the billing data elements) EMD Capable: Yes/No (This is not a NHTSA 2.2.1 data element but indicates whether to include EMD related data elements)

The EMS Patient Care Report Number must be generated by the software. It should be unique to the EMS System and fit within the requirements of the NHTSA Version 2.2.1 data dictionary. Required Data Elements which require software auto-generation: 1. E01_01: Patient Care Report Number

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Initial Patient Report Record Creation Screen

To best determine the required data elements which must be collected on each EMS event, it is important to first obtain key pieces of information. The following data elements should be collected on the first screen associated with an EMS Patient Care Report. In the pages that follow each of these data elements will then be used to describe which sections and/or data elements within a section are required. 1. E20_10: Incident/Patient Disposition Cancelled Defined as an EMS event where the responding EMS unit was cancelled prior to arriving at the scene. Therefore not patient evaluation or treatment occurs. Dead at Scene Defined as an EMS event where the patient is dead on arrival of the EMS unit. No care is provided to the patient other than documentation of the event and confirmation that the patient is dead. If any care is provided, the patient is not considered dead and should be documented as one of the Treated choices. No Patient Found Defined as an EMS event where EMS arrives at the scene but no patient is identified. No patient evaluation or care is provided. No Treatment Required Defined as an EMS event where EMS arrives and evaluates a patient but no treatment or treatment protocol is required. This could result in documentation of an assessment but not procedures, medications, or transport was provided. If a treatment protocol, procedure, or medication is provided, the event should be classified as on of the Treated choices. Patient Refused Care Defined as an EMS event where EMS arrives and attempts to evaluate and treat the patient but the patient refuses care at some point in the evaluation. This could result in the documentation of the portion of the assessment and treatment provided. If the patient is transported, one of the Treated, Transported by choices should be used. Treated and Released Defined as an EMS event where EMS arrives and fully evaluates and treats the patient but no transport is needed for additional care or evaluation. Any patient who is transported to a healthcare facility should be documented through one of the Treated, Transported to choices. Treated, Transferred Care Defined as an EMS event where EMS arrives, evaluates, and treats the patient but then transfers the care of the patient to another EMS unit (ground or air). Destination for these events is considered the location where the care of the patient was formally transferred. 2006 EMS Performance Improvement Center (www.EMSPIC.org) Page 2 of 20

 Treated, Transported by EMS Defined as an EMS event where EMS arrives, evaluates, treats, and transports the patient. Treated, Transported by Law Enforcement Defined as an EMS event where EMS arrives, evaluates, and treats the patient but the patient is transported by Law Enforcement. Destination of the patient is considered appropriate for EMS to document even though EMS is not transporting the patient. Treated, Transported by Private Vehicle Defined as an EMS event where EMS arrives, evaluates, and treats the patient but the patient is transported by Private Vehicle. Destination of the patient is considered appropriate for EMS to document even though EMS is not transporting the patient. 2. E09_04: Possible Injury Yes, MVC (mapped to Yes) Defined as an EMS event where the patient has been exposed to a traumatic event with a potential or known injury associated with a Motor Vehicle Crash. This value should be used internally by the EMS software to determine which injury related data elements should be presented to the user. This value is equivalent to Yes for E09_04. Yes, Fall (mapped to Yes) Defined as an EMS event where the patient has been exposed to a traumatic event with a potential or known injury associated with a Fall. This value should be used internally by the EMS software to determine which injury related data elements should be presented to the user. This value is equivalent to Yes for E09_04. Yes, Other Defined as an EMS event where the patient has been exposed to a traumatic event with a potential or known injury other than a fall or motor vehicle crash. This value should be used internally by the EMS software to determine which injury related data elements should be presented to the user. This value is equivalent to Yes for E09_04. No Defined as an EMS event where the patient has not been exposed to a traumatic event with a potential or known injury. This value should be used internally by the EMS software to determine which injury related data elements should be presented to the user. This value is equivalent to No for E09_04. 3. E11_01: Cardiac Arrest Yes, Prior to EMS Arrival Defined as an EMS event where the patient has experienced a cardiac arrest before the arrival of EMS. The patient may or may not be in cardiac arrest at the time EMS arrives. 2006 EMS Performance Improvement Center (www.EMSPIC.org) Page 3 of 20

 Yes, After EMS Arrival Defined as an EMS event where the patient has experienced a cardiac arrest after this EMS unit has arrived and the patient is under EMS care. No Defined as an EMS event where the patient is not experiencing a cardiac arrest and does not experience one during the time the patient is under EMS care. The following information serves as a legend for the table below: X = should be completed Number = See footnotes for completion requirement N = Null Value required because the data element is a National Element and required via the XSD Any area shaded Yellow indicates the data element is not required but a null value must be inserted. This data element should not be presented to the user but auto filled based on this logic. Any area shaded in Light Blue indicates the data element is not required by PreMIS (should not be presented to the included in the application) but should be completed by NEMSIS Gold If a field in the table is shaded Dark Blue, the field is not required and should not be presented to the user for completion

Treated, Transported by EMS

Treated, Transported by Law X X

Patient Refused Care

No Treatment Required

Section E01: Record Information E01_01: Patient Care Report Number Section E02: Unit/Agency Information E02_01: EMS Agency Number

X X

X X

X X

X X

X X

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

X X

X X

X X

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Treated, Transported by PV X X

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law X X X X X X X X X X X X X X X X X X X

Patient Refused Care

No Treatment Required

E02_02: E02_03: E02_04: E02_05: E02_06: E02_07: E02_08: E02_09: E02_10: E02_11: E02_12: E02_13: E02_14: E02_15: E02_16: E02_17:

Incident Number EMS Unit (Vehicle) Response Number Type of Service Requested Primary Role of the Unit Type of Dispatch Delay Type of Response Delay Type of Scene Delay Type of Transport Delay Type of Turn-Around Delay EMS Unit/Vehicle Number EMS Unit Call Sign (Radio Number) Vehicle Dispatch Location Vehicle Dispatch Zone Vehicle Dispatch GPS Location Beginning Odometer of Responding Vehicle On-Scene Odometer of Responding Vehicle

X X X X X X N N N X X X X X X

E02_18: Destination Odometer of Responding Vehicle E02_19: Ending Odometer of Responding Vehicle E02_20: Response Mode to Scene Section E03: Unit/Call Information E03_01: Complaint Reported by Dispatch

X X X

X X X X X X X X X X X X X X X X X X X X

X X X X X X X N N X X X X X X X X X X

X X X X X X X N X X X X X X X X X X X

X X X X X X X N X X X X X X X X X X X

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

X X X X X X X N X X X X X X X X X X X

X X X X X X X N X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X

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Treated, Transported by PV X X X X X X X X X X X X X X X X X X X

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law 3 3 X X X X X X X X X X X X X

Patient Refused Care

No Treatment Required

E03_02: EMD Performed E03_03: EMD Card Number Section E04: Unit/Personnel Information E04_01: Crew Member ID E04_02: Crew Member Role E04_03: Crew Member Level Section E05: Times E05_01: E05_02: E05_03: E05_04: E05_05: E05_06: E05_07: E05_08: E05_09: E05_10: E05_11: E05_12: E05_13: Incident or Onset Date/Time PSAP Call Date/Time Dispatch Notified Date/Time Unit Notified by Dispatch Date/Time Unit En Route Date/Time Unit Arrived on Scene Date/Time Arrived at Patient Date/Time Transfer of Patient Care Date/Time Unit Left Scene Date/Time Patient Arrived at Destination Date/Time Unit Back in Service Date/Time Unit Cancelled Date/Time Unit Back at Home Location Date/Time

3 3 X X X X X X X X N N N N X X X

3 3 X X X X X X X X X X X X X X

3 3 X X X X X X X X X N X X X

3 3 X X X X X X X X X X X X X

3 3 X X X X X X X X X X X X X

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

3 3 X X X X X X X X X X X X X

3 3 X X X X X X X X X X X X X X

3 3 X X X X X X X X X X X X X X

Section E06: Patient 2006 EMS Performance Improvement Center (www.EMSPIC.org) Page 6 of 20

Treated, Transported by PV 3 3 X X X X X X X X X X X X X

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law X X X X X X X X X X X X X X X X X X X X

Patient Refused Care

No Treatment Required

E06_01: E06_02: E06_03: E06_04: E06_05: E06_06: E06_07: E06_08: E06_09: E06_10: E06_11: E06_12: E06_13: E06_14: E06_15: E06_16: E06_17: E06_18: E06_19:

Last Name First Name Middle Initial/Name Patients Home Address Patients Home City Patients Home County Patients Home State Patients Home Zip Code Patients Home Country Social Security Number Gender Race Ethnicity Age Age Units Date of Birth Primary or Home Telephone Number State Issuing Drivers License Drivers License Number

N N N N N

X X X X X X X X X X X X X X X X X X X X

N N N N N

X X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

X X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X

Section E07: Billing E07_01: Primary Method of Payment

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Treated, Transported by PV X X X X X X X X X X X X X X X X X X X X

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

Patient Refused Care

No Treatment Required

E07_02: E07_03: E07_04: E07_05: E07_06: E07_07: E07_08: E07_09: E07_10: E07_11: E07_12: E07_13: E07_14:

Certificate of Medical Necessity Insurance Company ID/Name Insurance Company Billing Priority Insurance Company Address Insurance Company City Insurance Company State Insurance Company Zip Code Insurance Group ID/Name Insurance Policy ID Number Last Name of the Insured First Name of the Insured Middle Initial/Name of the Insured Relationship to the Insured

E07_15: Work-Related E07_16: Patients Occupational Industry E07_17: Patients Occupation E07_18: Closest Relative/Guardian Last Name E07_19: First Name of the Closest Relative/ Guardian E07_20: Middle Initial/Name of Relative/Guardian E07_21: Closest Relative/ Guardian Street Address E07_22: Closest Relative/ Guardian City E07_23: Closest Relative/ Guardian State 2006 EMS Performance Improvement Center (www.EMSPIC.org)

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

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Treated, Transported by PV 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law 4 4 4 4 4 4 4 4 4 4 4 4 4 4 X X X X X X

Patient Refused Care

No Treatment Required

E07_24: E07_25: E07_26: E07_27: E07_28: E07_29: E07_30: E07_31: E07_32: E07_33: E07_34: E07_35:

Closest Relative/ Guardian Zip Code Closest Relative/ Guardian Phone Number Closest Relative/ Guardian Relationship Patients Employer Patients Employers Address Patients Employers City Patients Employers State Patients Employers Zip Code Patients Work Telephone Number Response Urgency CMS Service Level Condition Code Number

N N

E07_36: ICD-9 Code for the Condition Code Number E07_37: Modifier for Condition Code Number Section E08: Scene E08_01: E08_02: E08_03: E08_04: E08_05: E08_06: Other EMS Agencies at Scene Other Services at Scene Estimated D/T Initial Resp. Arrived on Scene Date/Time Initial Responder Arrived on Scene Number of Patients at Scene Mass Casualty Incident

4 4 4 4 4 4 4 4 4 4 4 4 4 4 X X X X X X

N N

4 4 4 4 4 4 4 4 4 4 4 4 4 4 X X X X X X

4 4 4 4 4 4 4 4 4 4 4 4 4 4 X X X X X X

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

4 4 4 4 4 4 4 4 4 4 4 4 4 4 X X X X X X

4 4 4 4 4 4 4 4 4 4 4 4 4 4 X X X X X X

4 4 4 4 4 4 4 4 4 4 4 4 4 4 X X X X X X

N N

X X X X X X

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Treated, Transported by PV 4 4 4 4 4 4 4 4 4 4 4 4 4 4 X X X X X X

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law X X X X X X X X X X X X 1 X X X X X X X

Patient Refused Care

No Treatment Required

E08_07: E08_08: E08_09: E08_10: E08_11: E08_12: E08_13: E08_14: E08_15:

Incident Location Type Incident Facility Code Scene Zone Number Scene GPS Location Incident Address Incident City Incident County Incident State Incident ZIP Code

N N N N 1

X X X X X X X X X X X X 1 X X X X X X X

X X X X X X X X X N N N 1

X X X X X X X X X X X X 1 X X X X X X X

X X X X X X X X X X X X 1 X X X X X X X

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

X X X X X X X X X X X X 1 X X X X X X X

X X X X X X X X X X X X 1 X X X X X X X

X X X X X X X X X X X X 1 X X X X X X X

Section E09: Situation E09_01: Prior Aid E09_02: E09_03: E09_04: E09_05: E09_06: E09_07: E09_08: E09_09: E09_10: E09_11: Prior Aid Performed by Outcome of the Prior Aid Injury Present Chief Complaint Narrative Duration of Chief Complaint Time Units of Duration of Chief Complaint Secondary Complaint Narrative Duration of Secondary Complaint Time Units of Duration of Secondary Complaint Complaint Anatomic Location

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Treated, Transported by PV X X X X X X X X X X X X 1 X X X X X X X

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law X X X X X 5 5 5 5 5 5 5 5 5 5 1 6 6 6

Patient Refused Care

No Treatment Required

E09_12: E09_13: E09_14: E09_15: E09_16: E10_01: E10_02: E10_03: E10_04: E10_05: E10_06: E10_07: E10_08: E10_09: E10_10: E11_01: E11_02: E11_03: E11_04:

Complaint Organ Agency Primary Symptom Other Associated Symptoms Providers Primary Impression Providers Secondary Impression Cause of Injury Intent of the Injury Mechanism of Injury Vehicular Injury Indicators Area of the Vehicle impacted by the collision Seat Row Location of Patient in Vehicle Position of Patient in the Seat of the Vehicle Use of Occupant Safety Equipment Airbag Deployment Height of Fall Cardiac Arrest Cardiac Arrest Etiology Resuscitation Attempted Arrest Witnessed by

N N N N N N

X X X X X 5 5 5 5 5 5 5 5 5 5 1 6 6 6

N N N N N N

X X X X X 5 5 5 5 5 5 5 5 5 5 1 6 6 6

X X X X X 5 5 5 5 5 5 5 5 5 5 1 6 6 6

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

X X X X X 5 5 5 5 5 5 5 5 5 5 1 6 6 6

X X X X X 5 5 5 5 5 5 5 5 5 5 1 6 6 6

X X X X X 5 5 5 5 5 5 5 5 5 5 1 6 6 6

Section E10: Situation/Trauma

Section E11: Situation/Cardiac Arrest

1 N N

1 N N

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Treated, Transported by PV X X X X X 5 5 5 5 5 5 5 5 5 5 1 6 6 6

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law 6 6 6 6 6 6 6 X X X X X X X X X X X

Patient Refused Care

No Treatment Required

E11_05: E11_06: E11_07: E11_08: E11_09: E11_10: E11_11:

First Monitored Rhythm of the Patient Any Return of Spontaneous Circulation Neurological Outcome at Hospital Discharge Estimated Time of Arrest Prior to EMS Arrival Date/Time Resuscitation Discontinued Reason CPR Discontinued Cardiac Rhythm on Arrival at Destination

6 6 6 6 6 6 6 N X N

6 6 6 6 6 6 6 X

6 6 6 6 6 6 6 X

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

6 6 6 6 6 6 6 X

6 6 6 6 6 6 6 X X X X X X X X X X X X X

6 6 6 6 6 6 6 X X X X X X X X X X X X X

Section E12: Medical History E12_01: Barriers to Patient Care E12_02: Sending Facility Medical Record Number E12_03: E12_04: E12_05: E12_06: E12_07: E12_08: E12_09: E12_10: E12_11: E12_12: E12_13: Destination Medical Record Number First Name of Patients Primary Practitioner Middle Name of Patients Primary Practitioner Last Name of Patients Primary Practitioner Advanced Directives Medication Allergies Environmental/Food Allergies Medical/Surgical History Medical History Obtained From Immunization History Immunization Date

X X X X

X X X X X X X X X X

X X X X X X X X X X

X X X X X X X X X X

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Treated, Transported by PV 6 6 6 6 6 6 6 X X X X X X X X X X X

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law X X X X X X X X X X X X X X X X X X X

Patient Refused Care

No Treatment Required

E12_14: E12_15: E12_16: E12_17: E12_18: E12_19: E12_20:

Current Medications Current Medication Dose Current Medication Dosage Unit Current Medication Administration Route Presence of Emergency Information Form Alcohol/Drug Use Indicators Pregnancy

X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X

Section E13: Narrative E13_01: Run Report Narrative Section E14: Assessment/Vital Signs E14_01: E14_02: E14_03: E14_04: E14_05: E14_06: E14_07: E14_08: E14_09: E14_10: E14_11: Date/Time Vital Signs Taken Obtained Prior to this Units EMS Care Cardiac Rhythm SBP DBP Method of Blood Pressure Pulse Rate Electronic Monitor Rate Pulse Oximetry Pulse Rhythm Respiratory Rate

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Treated, Transported by PV X X X X X X X X X X X X X X X X X X X

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law X X X X X X X X X X X X X X X X X 5 5 5

Patient Refused Care

No Treatment Required

E14_12: E14_13: E14_14: E14_15: E14_16: E14_17: E14_18: E14_19: E14_20: E14_21: E14_22: E14_23: E14_24: E14_25: E14_26: E14_27: E14_28:

Respiratory Effort CO2 Blood Glucose Level GCS Eye GCS Verbal GCS Motor GCS Qualifier Total GCS Temperature Temperature Method Level of Responsiveness Pain Scale Stroke Scale Thrombolytic Screen APGAR RTS Pediatric Trauma Score

X X X X X X X X X X

X X X X X X X X X X X X X X X X X 5 5 5

X X X X X X X X X X X X X X X X X 5 5 5

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

X X X X X X X X X X X X X X X X X 5 5 5

X X X X X X X X X X X X X X X X X 5 5 5

X X X X X X X X X X X X X X X X X 5 5 5

Section E15: Assessment/Injury E15_01: NHTSA Injury Matrix External/Skin E15_02: NHTSA Injury Matrix Head E15_03: NHTSA Injury Matrix Face 2006 EMS Performance Improvement Center (www.EMSPIC.org)

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Treated, Transported by PV X X X X X X X X X X X X X X X X X 5 5 5

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law 5 5 5 5 5 5 5 5 X X X X X X X X X X X X X

Patient Refused Care

No Treatment Required

E15_04: E15_05: E15_06: E15_07: E15_08: E15_09: E15_10: E15_11:

NHTSA Injury Matrix Neck NHTSA Injury Matrix Thorax NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Spine NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Unspecified

5 5 5 5 5 5 5 5 X X X X X X X X X X X X X

5 5 5 5 5 5 5 5 X X X X X X X X X X X X X

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

5 5 5 5 5 5 5 5 X X X X X X X X X X X X X

5 5 5 5 5 5 5 5 X X X X X X X X X X X X X

5 5 5 5 5 5 5 5 X X X X X X X X X X X X X

Section E16: Assessment/Exam E16_01: Estimated Body Weight E16_02: Broselow/Luten Color E16_03: Date/Time of Assessment E16_04: Skin Assessment E16_05: Head/Face Assessment E16_06: Neck Assessment E16_07: Chest/Lungs Assessment E16_08: Heart Assessment E16_09: Abdomen Left Upper Assessment E16_10: Abdomen Left Lower Assessment E16_11: Abdomen Right Upper Assessment E16_12: Abdomen Right Lower Assessment E16_13: GU Assessment 2006 EMS Performance Improvement Center (www.EMSPIC.org)

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Treated, Transported by PV 5 5 5 5 5 5 5 5 X X X X X X X X X X X X X

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law X X X X X X X X X X X X X X X X X X X

Patient Refused Care

No Treatment Required

E16_14: E16_15: E16_16: E16_17: E16_18: E16_19: E16_20: E16_21: E16_22: E16_23: E16_24:

Back Cervical Assessment Back Thoracic Assessment Back Lumbar/Sacral Assessment Extremities-Right Upper Assessment Extremities-Right Lower Assessment Extremities-Left Upper Assessment Extremities-Left Lower Assessment Eyes-Left Assessment Eyes-Right Assessment Mental Status Assessment Neurological Assessment

X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X

Section E17: Intervention E17_01: Protocols Used Section E18: Intervention/Medications E18_01: E18_02: E18_03: E18_04: E18_05: E18_06: E18_07: Date/Time Medication Administered Medication Prior to Units EMS Care Medication Given Medication Administered Route Medication Dosage Medication Dosage Units Response to Medication

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Treated, Transported by PV X X X X X X X X X X X X X X X X X X X

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law X X X X X X X X X X X X X X X X X X X

Patient Refused Care

No Treatment Required

E18_08: E18_09: E18_10: E18_11:

Medication Complication Medication Crew Member ID Medication Authorization Medication Authorizing Physician

X X X X X X X X X X X X X X X X X X

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X

Section E19: Intervention/Procedures E19_01: Date/Time Procedure Performed Successfully E19_02: E19_03: E19_04: E19_05: E19_06: E19_07: E19_08: E19_09: E19_10: E19_11: E19_12: E19_13: E19_14: Procedure Performed Prior to Units EMS Care Procedure Size of Procedure Equipment Number of Procedure Attempts Procedure Successful Procedure Complication Response to Procedure Procedure Crew Members ID Procedure Authorization Procedure Authorizing Physician Successful IV Site Tube Confirmation Destination Confirmation of Tube Placement

N N N N

N N N N

N N N N

Section E20: Disposition E20_01: Destination/Transferred To, Name

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Treated, Transported by PV X X X X X X X X X X X X X X X X X X X

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law X X X X X X X X 1 N N N N N X X

Patient Refused Care

No Treatment Required

E20_02: E20_03: E20_04: E20_05: E20_06: E20_07: E20_08: E20_09: E20_10: E20_11: E20_12: E20_13: E20_14: E20_15: E20_16: E20_17: E22_01: E22_02: E22_03: E22_04:

Destination/Transferred To, Code Destination Street Address Destination City Destination State Destination County Destination Zip Code Destination GPS Location Destination Zone Number Incident/Patient Disposition How Patient Was Moved to Ambulance Position of Patient During Transport How Patient Was Transported From Ambulance Transport Mode from Scene Condition of Patient at Destination Reason for Choosing Destination Type of Destination Emergency Department Disposition Hospital Disposition Law Enforcement/Crash Report Number Trauma Registry ID

X X X X X X X X 1

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

N N N N N

X X X X N N X X

N N N N N

N N N N N X X

N N N N N X X

N N N N N X X

X X X X X X X X 1 X X X X X X X N N X X

X X X X X X X X 1 X X X X X X X X X X X

Section E22: Outcome and Linkage

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Treated, Transported by PV X X X X X X X X 1 N N N N N X X

Treated, Transferred Care

No Patient Found

Dead

Treated, Transported by EMS

Treated, Transported by Law X X X X X X X X X X X

Patient Refused Care

No Treatment Required

E22_05: Fire Incident Report Number E22_06: Patient ID Band/Tag Number Section E23: Miscellaneous E23_01: Review Requested E23_02: Potential Registry Candidate E23_03: Personal Protective Equipment Used E23_04: Suspected Intentional, or Unintentional Disaster E23_05: Contact Blood/Body Fluids, Injury, or Death E23_06: Type Blood/Body Exposure, Injury, or Death E23_07: Personnel Exposed E23_08: Required Reportable Conditions E23_09&11: Research Survey Field and Title E23_10: Who Generated this Report?

X X X X X X X X X X X X X X

X X X X X X X X X X X

X X X X X X X X X X X

Treated and Released

Appropriate NHTSA Data Element Completion Based on E20_10: Disposition Cancelled

X X X X X X X X X X X

X X X X X X X X X X X X

X X X X X X X X X X X X

X X X X X X X

X X X X X X X

1 = these data elements are used in the opening screen to determine which sections and data elements are required. They must be completed on all events. 3 = must be completed by the user if EMD Capable is answered as Yes. If EMD Capable is No, E03_02 and E03_03 should automatically have values inserted for Not Reporting and the User should not be presented with these data elements. 4 = must be completed if Billing is Yes. If Billing is No, E07_01, E07_34, and E07_35 should be completed by the User. All other data elements in the billing section should not be presented to the User and no date is required to be stored. 5 = must be completed based on the completion of E09_04 (Presumed Injury):
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Treated, Transported by PV X X X X X X X X X X X

Treated, Transferred Care

No Patient Found

Dead

 If Yes, MVC, all Section E10 data elements except E10_10 should be completed. All of Section E15 should be completed

as well. E10_10 should have the value Not Applicable inserted and the User should not be presented with the data element. If Yes, Fall, E10_01, E10_02, E10_03, and E10_10 should be completed by the user. All of Section E15 should be completed. All other Section E10 data elements should have the value Not Applicable inserted and the User should not be presented with the data element. If Yes, Other, E10_01, E10_02, and E10_03 should be completed by the User. All of Section E15 should be completed All other Section E10 data elements should have the value Not Applicable inserted and the User should not be presented with the data element. If No, None of the Section E10 or E15 data elements should be presented to the User for completion. E10_01 should have the value Not Applicable inserted and the User should not be presented with the data element. 6 = must be completed if E11_01 (Cardiac Arrest) = Yes as follows: If Yes, Prior to EMS Arrival, All Section E11 data elements should be presented to the User for data entry. If Yes, After EMS Arrival, All Section E11 data elements should be presented to the User for data entry. If No, E11_01, E11_02, and E11_03 should have the value Not Applicable inserted and the data elements should not be presented to the User for data entry. All of the remaining Section E11 data elements should have Not Applicable inserted and should not be presented to the User for data entry.

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