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National Emergency Medical Services Information System NH TEMSIS

Data Dictionary

Funded by

National Highway Traffic Safety Administration (NHTSA) EMS Division

WWW.NHTEMSIS.ORG

DefinitionThe state-assigned provider number of the responding agency

Field Values

National ElementData Format [text]D01_01EMS AGENCY NUMBER

Additional InformationAll EMS Agency demographic information is associated with the EMS agency number● Not Nullable. A unique value must be provided to create a unique record ID within a database● The same as EMS Agency Number (E02_01). This could be used to auto fill E02_01 on the Patient Care Report● This data element is unique and is typically sequential●

Other Associated ElementsEMS Agency NumberD01_01

References to Other DatabasesEMS Module; Title: Patient Number● NFIRS 5.0

A unique value; no variable list is possible.

UsesAgency 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 CollectorTypically generated by the State EMS Regulatory Office. Collected by the EMS agency or auto-generated by the EMS agency specific software.

●

EMSAgencyNumberXSD Domain (Simple Type)XSD Data Type xs:string

Multiple Entry Configuratio No

Required in XSD YesAccepts Null Value No

3 15Minimum Constraint Maximum Constraint

References in NHTSA Version 123 Patient Care Record NumberElement Desirable

Section D01 Agency General Information of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe state in which the Agency provides services

Field Values

National ElementData Format [combo] multiple-choiceD01_03EMS AGENCY STATE

Additional Information2 digit FIPS code● Not Nullable. A unique value must be provided to create a unique record ID within a database●


References to Other DatabasesEMS Module, Title: State● NFIRS 5.0

Appropriate 2 digit FIPS code●

UsesAgency 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 CollectorEMS Agency and typically only documented once then verified and updated yearly or when changed●

AgencyStateXSD Domain (Simple Type)XSD Data Type xs:string

Multiple Entry Configuratio Yes



Section D01 Agency General Information Page 4 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe county(s) for which the agency formally provides service

Field Values

National ElementData Format [combo] multiple-choiceD01_04EMS AGENCY COUNTY

Additional InformationStored 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

●


Appropriate 5 digit FIPS code●

UsesUsed to group data with a state●


AgencyCountyXSD Domain (Simple Type)XSD Data Type xs:string





DefinitionThe highest credentialed personnel's level of service which the agency provides for every EMS encounter if requested. In a tiered response system, this is the highest level of service which could be sent to any specific call.

Field Values

National ElementData Format [combo] single-choiceD01_07LEVEL OF SERVICE

Additional InformationThis list can be edited by each state to account for additional certification/licensure level by adding levels as listed in State Certification/Licensure Levels (D04_01). State Certification/Licensure levels (D04_01) should create the list for this item

●

This value is stored either as the appropriate code or in text if an additional certification/licensure level has been entered by a state

●


References to Other DatabasesEMS 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

● NFIRS 5.0

EMT-Basic6090 EMT-Intermediate6100EMT-Paramedic6110 Nurse6111Physician6112 First Responder6120

UsesAllows data to be sorted based on an agency's level of service● Provides description of EMS Personnel● Provides descriptive information when combined with an EMS Agency’s Billing Status●


DemographicStateCertificationLicensureLevelsXSD Domain (Simple Type)XSD Data Type xs:string/integer




References in NHTSA Version 129 Crew Member One TypeElement Essential30 Crew Member Two TypeElement Essential31 Crew Member Three TypeElement Desirable


DefinitionThe organizational structure from which EMS services are delivered (fire, hospital, county, etc.)

Field Values

National ElementData Format [combo] single-choiceD01_08ORGANIZATIONAL TYPE


Community, Non-Profit5810 Fire Department5820Governmental, Non-Fire5830 Hospital5840Private, Non_Hospital5850 Tribal5860

UsesAllows data to be sorted based on an agency's organizational structure● Provides description of EMS agencies across the nation●


OrganizationalTypeXSD Domain (Simple Type)XSD Data Type xs:string




DefinitionThe primary organizational status of the agency. The definition of Volunteer or Non-Volunteer is based on state or local terms.

Field Values

National ElementData Format [combo] single-choiceD01_09ORGANIZATION STATUS


Mixed5870 Non-Volunteer5880Volunteer5890

UsesAllows data to be sorted based on an agency's organizational status● Provides description of EMS agencies across the nation●


OrganizationStatusXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe National Provider Identifier associated with National Provider System (NPS) and used in all standard HIPAA transactions such as electronic claim filing.

Field Values

National ElementData Format [text]D01_21NATIONAL PROVIDER IDENTIFIER

Additional InformationThe National Provider Identifier is associated with the EMS agency number●


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5

UsesImportant for HIPAA related transactions such as electronic claims processing●

Data CollectorGenerated by the National Provider System within the United States Department of Health and Human Services. Collected by the EMS agency or auto-generated by the EMS agency specific software.

●

NationalProviderIdentifierXSD Domain (Simple Type)XSD Data Type xs:string


Required in XSD YesAccepts Null Value Yes



DefinitionThe ZIP code of the Agency contact's mailing address.

Field Values

National ElementData Format [text]D02_07AGENCY CONTACT ZIP CODE

Additional InformationCan be a 5 or 9 digit Zip Code●

Other Associated ElementsEMS Agency NumberD01_01 Agency Contact AddressD02_04Agency Contact CityD02_05 Agency Contact StateD02_06


UsesAllows data to be sorted into a geographical area● Component of the EMS Agency Contact Information/Address●


DemographicZipXSD Domain (Simple Type)XSD Data Type xs:string



5 10XSD Structure: D02_04, D02_05, D02_06, and D02_07 are all members of D02_04_0 Agency Contract Address

Minimum Constraint Maximum Constraint

Section D02 Agency Contact Information Page 30 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThese 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

Data Format [combo] single-choiceE00COMMON NULL VALUES

Additional InformationFor 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.

●

Not Applicable-25 Not Recorded-20Not Reporting-15 Not Known-10Not Available-5

Section E00 Common EMS Values Page 122 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe 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.

Field Values

National ElementData Format [text]E01_01PATIENT CARE REPORT NUMBER

Additional InformationNot Nullable. A unique value must be provided to create a unique record ID within a database●

Other Associated ElementsPatient Care Report NumberE01_01

References to Other DatabasesEMS Module; Title: Patient Number; Unique Number● NFIRS 5.0


UsesA 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 CollectorEMS agency or may be electronically provided through the 911 or dispatch center●

PatientCareReportNumberXSD Domain (Simple Type)XSD Data Type xs:string




References in NHTSA Version 123 Patient Care Record NumberElement Desirable

Section E01 Record Information Page 124 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe name of the software vendor by whom the data collection software was developed

Field Values

National ElementData Format [text]E01_02SOFTWARE CREATOR



UsesImportant for grouping or comparing the accuracy of software used by EMS agencies in data collection●


SoftwareCreatedByXSD Domain (Simple Type)XSD Data Type xs:string




Section E01 Record Information 5 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe name of the software package with which the data was collected by the agency

Field Values

National ElementData Format [text]E01_03SOFTWARE NAME





SoftwareNameXSD Domain (Simple Type)XSD Data Type xs:string





DefinitionThe version of the software used by the agency to collect the data

Field Values

National ElementData Format [text]E01_04SOFTWARE VERSION





SoftwareVersionXSD Domain (Simple Type)XSD Data Type xs:string





DefinitionThe state-assigned provider number of the responding agency

Field Values

National ElementData Format [text]E02_01EMS AGENCY NUMBER

Additional InformationNot Nullable. A unique value must be provided to create a unique record ID within a database● Same as EMS Agency Number (D01_01)●


References to Other DatabasesEMS Module;Title: FDID; State assigned Fire Department ID number● NFIRS 5.0


UsesA 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 CollectorTypically generated by the State EMS Regulatory Office. Collected by the EMS agency or auto-generated by the EMS agency specific software.

●

EMSAgencyNumberXSD Domain (Simple Type)XSD Data Type xs:string




Section E02 Unit/ Agency Information Page 129 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe incident number assigned by the 911 Dispatch System

Field Values

Data Format [text]E02_02INCIDENT NUMBER

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01

References to Other DatabasesEMS Module; Title: Incident Number; Unique number for each Incident● NFIRS 5.0

Not Applicable-25 Not Known-10Not Available-5 Relevant Value for Data Element & Patient Care●

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

●

Data Collector911 or Dispatch Center and electronically or verbally transmitted to the EMS agency●

IncidentNumberXSD Domain (Simple Type)XSD Data Type xs:string


Required in XSD NoAccepts Null Value Yes


References in NHTSA Version 121 Incident NumberElement Essential


DefinitionThe internal EMS response number which is unique for each EMS unit’s (vehicles) response to an incident within an agency.

Field Values

Data Format [text]E02_03EMS UNIT (VEHICLE) RESPONSE NUMBER



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

●


EMSUnitResponseNumberXSD Domain (Simple Type)XSD Data Type xs:string




References in NHTSA Version 122 Response NumberElement Essential


DefinitionThe type of service or category of service requested of the EMS service responding for this specific EMS incident.

Field Values

National ElementData Format [combo] single-choiceE02_04TYPE OF SERVICE REQUESTED


911 Response (Scene)30 Intercept35Interfacility Transfer40 Medical Transport45Mutual Aid50 Standby55

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted by the Type of Service Requested● Provides descriptive data on EMS call volume and service provided●


TypeOfServiceRequestedXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 120 Service TypeElement Essential


DefinitionThe primary role of the EMS service which was requested for this specific EMS incident.

Field Values

National ElementData Format [combo] single-choiceE02_05PRIMARY ROLE OF THE UNIT


Non-Transport60 Rescue65Supervisor70 Transport75

UsesA 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●


PrimaryRollOfTheUnitXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe dispatch delays, if any, associated with the dispatch of the EMS unit to the patient encounter

Field Values

National ElementData Format [combo] multiple-choiceE02_06TYPE OF DISPATCH DELAY


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Caller (Uncooperative)80 High Call Volume85Language Barrier90 Location (Inability to Obtain)95No Units Available100 None105Other110 Scene Safety (Not Secure for EMS)115Technical Failure (Computer, Phone etc.)120

UsesAllows data to describe the status of Dispatch issues●


TypeOfDispatchDelayXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 156 Factors Affecting EMS Delivery of CareElement Desirable


DefinitionThe response delays, if any, of the unit associated with the patient encounter

Field Values

National ElementData Format [combo] multiple-choiceE02_07TYPE OF RESPONSE DELAY


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Crowd125 Directions130Distance135 Diversion140HazMat145 None150Other155 Safety160Staff Delay165 Traffic170Vehicle Crash175 Vehicle Failure180Weather185

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

Data CollectorEMS personnel●

TypeOfResponseDelayXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe scene delays, if any, of the unit associated with the patient encounter

Field Values

National ElementData Format [combo] multiple-choiceE02_08TYPE OF SCENE DELAY


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Crowd190 Directions195Distance200 Diversion205Extrication >20 min.210 HazMat215Language Barrier220 None225Other230 Safety235Staff Delay240 Traffic245Vehicle Crash250 Vehicle Failure255Weather260

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


TypeOfSceneDelayXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe transport delays, if any, of the unit associated with the patient encounter

Field Values

National ElementData Format [combo] multiple-choiceE02_09TYPE OF TRANSPORT DELAY


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Crowd265 Directions270Distance275 Diversion280HazMat285 None290Other295 Safety300Staff Delay305 Traffic310Vehicle Crash315 Vehicle Failure320Weather325

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


TypeOfTransportDelayXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe turn-around delays, if any, associated with the EMS unit associated with the patient encounter

Field Values

National ElementData Format [combo] multiple-choiceE02_10TYPE OF TURN-AROUND DELAY


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Clean-up330 Decontamination335Documentation340 ED Overcrowding345Equipment Failure350 Equipment Replenishment355None360 Other365Staff Delay370 Vehicle Failure375

UsesAllows data describe ED overcrowding and Vehicle Failure● Allows data to describe the status of call time issues●


TypeOfTurnAroundDelayXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe unique physical vehicle number of the responding unit

Field Values

Data Format [combo] single-choiceE02_11EMS UNIT/VEHICLE NUMBER

Additional InformationList box created from EMS Unit/Vehicle Number (D06_01)●



UsesA component of the EMS Medical Record: Patient Care Report● Allows data at the vehicle level to better describe EMS vehicle usage and possibly maintenance ● Important for grouping or comparing data by Response Vehicle which also allows data to be sorted by location in many agencies

●


EMSUnitNumberXSD Domain (Simple Type)XSD Data Type xs:string




References in NHTSA Version 124 Agency/Unit NumberElement Essential


DefinitionThe EMS unit number used to dispatch and communicate with the unit. This may be the same as the EMS Unit/Vehicle Number in many agencies.

Field Values

National ElementData Format [combo] single-choiceE02_12EMS UNIT CALL SIGN (RADIO NUMBER)

Additional InformationList box created from Unit Call Sign (D04_02)● Not Nullable. A unique value must be provided to create a unique record ID within a database●


Relevant Value for Data Element & Patient Care●

UsesAllows data at the vehicle level to better describe EMS vehicle usage and possibly maintenance ● Important for grouping or comparing data by Response Vehicle which also allows data to be sorted by location in many agencies

●


EMSUnitCallSignXSD Domain (Simple Type)XSD Data Type xs:string





DefinitionThe mileage (odometer reading) of the vehicle at the beginning of the call (when the wheels begin moving)

Field Values

Data Format [number]E02_16BEGINNING ODOMETER READING OF RESPONDING VEHICLE

Additional InformationNumber recorded with one digit to the right of decimal●



UsesImportant for EMS billing● Important for grouping or comparing data by dispatch 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●


OdometerReadingXSD Domain (Simple Type)XSD Data Type xs:decimal


Required in XSD NoAccepts Null Value No

0 999999.9Minimum Constraint Maximum Constraint


DefinitionThe mileage (odometer reading) of the vehicle when it arrives at the patient

Field Values

Data Format [number]E02_17ON-SCENE ODOMETER READING OF RESPONDING VEHICLE





●








DefinitionThe mileage (odometer reading) of the vehicle when it arrives at the patient’s destination

Field Values

Data Format [number]

E02_18PATIENT DESTINATION ODOMETER READING OF RESPONDING VEHICLE





●








DefinitionThe ending mileage (odometer reading) of the vehicle (at time back in service)

Field Values

Data Format [number]E02_19ENDING ODOMETER READING OF RESPONDING VEHICLE





●








DefinitionIndication whether or not lights and/or sirens were used on the vehicle on the way to the scene

Field Values

National ElementData Format [combo] single-choiceE02_20RESPONSE MODE TO SCENE


Initial Lights and Sirens, Downgraded to No Lights or Sirens

380 Initial No Lights or Sirens, Upgraded to Lights and Sirens

385

Lights and Sirens390 No Lights or Sirens395

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted by the Response Mode● Allows data to describe the use of emergent response●


ResponseModeToSceneXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 119 Lights and Sirens to SceneElement Essential


DefinitionThe complaint dispatch reported to the responding unit.

Field Values

National ElementData Format [combo] single-choiceE03_01COMPLAINT REPORTED BY DISPATCH


References to Other DatabasesChief Complaint TypesNHTSA EMD Data Element

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Abdominal Pain400 Allergies405Animal Bite410 Assault415Back Pain420 Breathing Problem425Burns430 CO Poisoning/Hazmat435Cardiac Arrest440 Chest Pain445Choking450 Convulsions/Seizure455Diabetic Problem460 Drowning465Electrocution470 Eye Problem475Fall Victim480 Headache485Heart Problems490 Heat/Cold Exposure495Hemorrhage/Laceration500 Industrial Accident/Inaccessible Incident/Other

Entrapments (non-vehicle)505

Ingestion/Poisoning510 Pregnancy/Childbirth515Psychiatric Problem520 Sick Person525Stab/Gunshot Wound530 Stroke/CVA535Traffic Accident540 Traumatic Injury545Unconscious/Fainting550 Unknown Problem Man Down555Transfer/Interfacility/Palliative Care560 MCI (Mass Casualty Incident)565

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted by the Dispatch Complaint● Allows data to describe Patient Complaint as reported by Dispatch●


ComplaintReportedByDispatchXSD Domain (Simple Type)XSD Data Type xs:integer



Section E03 Unit/ Call Information Page 150 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionIndication of whether EMD was performed for this EMS event.

Field Values

National ElementData Format [combo] single-choiceE03_02EMD PERFORMED


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5No0 Yes, With Pre-Arrival Instructions570Yes, Without Pre-Arrival Instructions575

UsesAllows data to be sorted by the Dispatch Complaint● Allows data to describe Patient Complaint as reported by Dispatch●


EMDPerformedXSD Domain (Simple Type)XSD Data Type xs:integer



Section E03 Unit/ Call Information Page 151 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe State Certification/Licensure ID number assigned to the crew member

Field Values

Data Format [text]E04_01CREW MEMBER ID

Additional InformationA 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

●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Crew Member RoleE04_02 Crew Member LevelE04_03


UsesA 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●


CrewMemberIDXSD Domain (Simple Type)XSD Data Type xs:string

Multiple Entry Configuratio Yes, via structure


2 15XSD Structure: E04_01, E04_02, E04_03 are all members of the E04 Unit Personnel Information structure


References in NHTSA Version 126 Crew Member One NumberElement Essential27 Crew Member Two NumberElement Essential28 Crew Member Three NumberElement Desirable

Section E04 Unit/ Personnel Information Page 154 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe 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.

Field Values

Data Format [combo] single-choiceE04_02CREW MEMBER ROLE

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Crew Member IDE04_01 Crew Member LevelE04_03

Not Applicable-25 Not Known-10Not Available-5 Driver580Primary Patient Caregiver585 Secondary Patient Caregiver590Third Patient Caregiver595 Other600



CrewMemberRoleXSD Domain (Simple Type)XSD Data Type xs:integer



XSD Structure: E04_01, E04_02, E04_03 are all members of the E04 Unit Personnel Information structure


DefinitionThe functioning level of the crew member during this EMS patient encounter.

Field Values

Data Format [combo] single-choiceE04_03CREW MEMBER LEVEL

Additional InformationCould 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 ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Crew Member IDE04_01 Crew Member RoleE04_02

References to Other DatabasesEMS 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

● NFIRS 5.0

Not Applicable-25 Not Known-10Not Available-5 Student635Other Healthcare Professional640 Other Non-Healthcare Professional645EMT-Basic6090 EMT-Intermediate6100EMT-Paramedic6110 Nurse6111Physician6112 First Responder6120



CrewMemberLevelXSD Domain (Simple Type)XSD Data Type xs:integer



XSD Structure: E04_01, E04_02, E04_03 are all members of the E04 Unit Personnel Information structure

References in NHTSA Version 129 Crew Member One TypeElement Essential30 Crew Member Two TypeElement Essential31 Crew Member Three TypeElement Desirable


DefinitionThe date/time the injury occurred, or the date/time the symptoms or problem started

Field Values

Data Format [date/time]E05_01INCIDENT OR ONSET DATE/TIME

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

●


References to Other DatabasesBasic Module 1; Title: Incident Date; Date Field defined as YYYYMMDD or blank● NFIRS 5.0


UsesImportant 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●


DateTimeXSD Domain (Simple Type)XSD Data Type xs:dateTime


Required in XSD NoAccepts Null Value Yes, but null value is blank or empty


References in NHTSA Version 106 Onset DateElement Desirable07 Onset TimeElement Desirable

Section E05 Times Page 158 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe date/time the phone rings (911 call to public safety answering point or other designated entity) requesting EMS services.

Field Values

National ElementData Format [date/time]E05_02PSAP CALL DATE/TIME


●


References to Other DatabasesEMS Module; Title: Incident Date; The date the Fire Department received the incident alarm● NFIRS 5.0


UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on Date and Time● Allows data to describe EMS use by Date and Time, Day of the Week, etc●




Required in XSD YesAccepts Null Value Yes, but null value is blank or empty


References in NHTSA Version 108 Date Incident ReportedElement Essential09 Time Incident ReportedElement Essential


DefinitionThe date/time dispatch was notified by the 911 call taker (if a separate entity)

Field Values

Data Format [date/time]E05_03DISPATCH NOTIFIED DATE/TIME


●



UsesProvides information on how EMS requests are progressing through the PSAP and Dispatch Centers● Used in the Quality Management evaluation of the PSAP and Dispatch Centers●






References in NHTSA Version 110 Time Dispatch NotifiedElement Essential


DefinitionThe date the responding unit was notified by dispatch

Field Values

National ElementData Format [date/time]E05_04UNIT NOTIFIED BY DISPATCH DATE/TIME


●

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



UsesA 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 111 Date Unit NotifiedElement Essential12 Time Unit NotifiedElement Essential


DefinitionThe date/time the unit responded; that is, the time the vehicle started moving

Field Values

National ElementData Format [date/time]E05_05UNIT EN ROUTE DATE/TIME


●









References in NHTSA Version 113 Time Unit RespondingElement Essential


DefinitionThe date/time the responding unit arrived on the scene; that is, the time the vehicle stopped moving

Field Values

National ElementData Format [date/time]E05_06UNIT ARRIVED ON SCENE DATE/TIME


●









References in NHTSA Version 114 Time of Arrival at SceneElement Essential


DefinitionThe date/time the responding unit arrived at the patient's side

Field Values

National ElementData Format [date/time]E05_07ARRIVED AT PATIENT DATE/TIME


●


References to Other DatabasesEMS Module; Title: Date/Time Arrived; The date and time fire fighters arrived at the patient.● NFIRS 5.0


UsesProvides more accurate information on the true response time of EMS to the patient’s side● Used in Quality Management evaluation of EMS response and performance especially in areas where patient location may be distant from the EMS vehicle

●






References in NHTSA Version 115 Time of Arrival at PatientElement Essential


DefinitionThe date/time the patient was transferred from this EMS agency to another EMS agency for care.

Field Values

Data Format [date/time]E05_08TRANSFER OF PATIENT CARE DATE/TIME


●


References to Other DatabasesEMS Module; Title: Date/Time Transfer; The date and time fire fighters transferred the care of the patient to another EMS agency.

● NFIRS 5.0


UsesImportant for Quality Management when the patient is cared for by more than one EMS agency● Provides documentation of how the patient progresses through the EMS agency●







DefinitionThe date/time the responding unit left the scene (started moving)

Field Values

National ElementData Format [date/time]E05_09UNIT LEFT SCENE DATE/TIME


●









References in NHTSA Version 116 Time Unit Left SceneElement Essential


DefinitionThe date/time the responding unit arrived with the patient at the destination or transfer point

Field Values

National ElementData Format [date/time]E05_10PATIENT ARRIVED AT DESTINATION DATE/TIME


●









References in NHTSA Version 117 Time of Arrival at DestinationElement Essential


DefinitionThe date/time the unit back was back in service and available for response (finished with call, but not necessarily back in home location)

Field Values

National ElementData Format [date/time]E05_11UNIT BACK IN SERVICE DATE/TIME


●









References in NHTSA Version 118 Time Back in ServiceElement Essential


DefinitionThe date/time if the unit's call was cancelled

Field Values

Data Format [date/time]E05_12UNIT CANCELLED DATE/TIME


●



UsesAllows for reports to be generated better evaluating EMS response and usage patterns●







DefinitionThe date/time the responding unit was back in their service area. In agencies who utilized Agency Status Management, home location means the service area as assigned through the agency status management protocol.

Field Values

National ElementData Format [date/time]E05_13UNIT BACK AT HOME LOCATION DATE/TIME


●



UsesAllows data to be sorted based on EMS agency time intervals● Allows data to describe EMS agency time intervals●







DefinitionThe patient's last (family) name

Field Values

Data Format [text]E06_01LAST NAME

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

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01First NameE06_02 Middle Initial/NameE06_03


UsesAllows 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 CollectorEMS personnel or electronically through linkage with a pre-existing Patient Care Report or hospital database●

LastNameXSD Domain (Simple Type)XSD Data Type xs:string



2 20XSD Structure: E06_01, E06_02, and E06_03 are all members of the E06_01_0 Patient Name Structure


References in NHTSA Version 132 Patient NameElement Essential

Section E06 Patient Page 172 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe patient's first (given) name

Field Values

Data Format [text]E06_02FIRST NAME


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Middle Initial/NameE06_03




FirstNameXSD Domain (Simple Type)XSD Data Type xs:string







DefinitionThe patient's middle name, if any

Field Values

Data Format [text]E06_03MIDDLE INITIAL/NAME


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 First NameE06_02




MiddleInitialNameXSD Domain (Simple Type)XSD Data Type xs:string







DefinitionThe patient's home mailing or street address

Field Values

Data Format [text]E06_04PATIENT'S HOME ADDRESS

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Patient's Home CityE06_05Patient's Home CountyE06_06 Patient's Home StateE06_07Patient's Home Zip CodeE06_08


UsesKey component of an EMS Medical Record● Provides contact information for multiple purposes including follow-up, billing, bioterrorism syndromic surveillance, etc●


StreetAddressXSD Domain (Simple Type)XSD Data Type xs:string



2 30XSD Structure: E06_04, E06_05, E06_06, E06_07, E06_08 are all members of the E06_04_0 Patient Address Structure


References in NHTSA Version 133 Patient Street AddressElement Desirable


DefinitionThe patient's home city or township or residence

Field Values

Data Format [combo] single-choiceE06_05PATIENT'S HOME CITY

Additional Information5 digit FIPS Code● Could be filled in from Patient’s Home Zip (E06_08)●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Patient's Home AddressE06_04Patient's Home CountyE06_06 Patient's Home StateE06_07Patient's Home Zip CodeE06_08




CityXSD Domain (Simple Type)XSD Data Type xs:string





References in NHTSA Version 134 City of ResidenceElement Desirable


DefinitionThe patient's home county or parish or residence

Field Values

Data Format [combo] single-choiceE06_06PATIENT'S HOME COUNTY

Additional InformationStored as a 5 digit FIPS code (combining the state and county code) to take into account agencies may server more than one state and counties are often named the same from state to state

●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Patient's Home AddressE06_04Patient's Home CityE06_05 Patient's Home StateE06_07Patient's Home Zip CodeE06_08




CountyXSD Domain (Simple Type)XSD Data Type xs:string





References in NHTSA Version 135 County of ResidenceElement Desirable


DefinitionThe patient's home state, territory, or province, or District of Columbia, where the patient resides

Field Values

Data Format [combo] single-choiceE06_07PATIENT'S HOME STATE

Additional Information2 digit FIPS Code● Could be filled in from Patient’s Home Zip (E06_08)●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Patient's Home AddressE06_04Patient's Home CityE06_05 Patient's Home CountyE06_06Patient's Home Zip CodeE06_08




StateXSD Domain (Simple Type)XSD Data Type xs:string





References in NHTSA Version 136 State of ResidenceElement Desirable


DefinitionThe patient's home ZIP code of residence

Field Values

National ElementData Format [text]E06_08PATIENT'S HOME ZIP CODE

Additional InformationCan be stored as a 5 or 9 digit code●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Patient's Home AddressE06_04Patient's Home CityE06_05 Patient's Home CountyE06_06Patient's Home StateE06_07

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Relevant Value for Data Element & Patient Care●

UsesAllows data to be sorted based on the geographic location of the patient's home● Allows data to describe geographic location of the patient's home● Key component of an EMS Medical Record● Provides contact information for multiple purposes including follow-up, billing, bioterrorism syndromic surveillance, etc●


ZipXSD Domain (Simple Type)XSD Data Type xs:string





References in NHTSA Version 137 Zip Code of ResidenceElement Essential


DefinitionThe patient’s country of citizenship

Field Values

Data Format [combo] single-choiceE06_09PATIENT’S HOME COUNTRY

Additional InformationStored as a FIPS code●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01




CountryXSD Domain (Simple Type)XSD Data Type xs:string





DefinitionThe patient's social security number

Field Values

Data Format [number]E06_10SOCIAL SECURITY NUMBER



UsesKey component of an EMS Medical Record●


SocialSecurityNumberXSD Domain (Simple Type)XSD Data Type xs:string




References in NHTSA Version 139 Social Security NumberElement Desirable


DefinitionThe patient's gender

Field Values

National ElementData Format [combo] single-choiceE06_11GENDER


References to Other DatabasesEMS Module; Title: Gender; Pick-List: Male = 1, Female = 2● NFIRS 5.0

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Male650 Female655

UsesA 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●


GenderXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 142 GenderElement Essential


DefinitionThe patient's race as defined by the OMB (US Office of Management and Budget)

Field Values

National ElementData Format [combo] single-choiceE06_12RACE


References to Other DatabasesEMS Module; Title: Race; Pick-List: White = 1, Black = 2, American Indian, Eskimo, Aleut = 3, Asian = 4, Other, Multi-racial = 0, Race Undetermined = U

● NFIRS 5.0

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5American Indian or Alaska Native660 Asian665Black or African American670 Native Hawaiian or Other Pacific Islander675White680 Other Race685

UsesA 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●


RaceXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 143 Race/EthnicityElement Essential


DefinitionThe patient's ethnicity as defined by the OMB (US Office of Management and Budget)

Field Values

National ElementData Format [combo] single-choiceE06_13ETHNICITY


References to Other DatabasesEMS Module; Title: Ethnicity; Check-Box: Hispanic = Yes or No● NFIRS 5.0

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Hispanic or Latino690 Not Hispanic or Latino695

UsesA 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●


EthnicityXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 143 Race/EthnicityElement Essential


DefinitionThe patient's age (either calculated from date of birth or best approximation)

Field Values

National ElementData Format [number]E06_14AGE

Additional InformationCould be calculated from Date of Birth (E06_16)●

Other Associated ElementsPatient Care Report NumberE01_01 Last NameE06_01Age UnitsE06_15

References to Other DatabasesEMS Module; Title: Age; The age of the patient or best approximation. If less than one year then enter the number of months.

● NFIRS 5.0


UsesA 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●


AgeXSD Domain (Simple Type)XSD Data Type xs:integer



1 120XSD Structure: E06_14 and E06_15 are members of the E06_14_0 Patient's Age Structure


References in NHTSA Version 141 AgeElement Desirable


DefinitionThe units which the age is documented in (Hours, Days, Months, Years)

Field Values

National ElementData Format [combo] single-choiceE06_15AGE UNITS

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01AgeE06_14

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Hours700 Days705Months710 Years715

UsesA 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●


AgeUnitsXSD Domain (Simple Type)XSD Data Type xs:integer



XSD Structure: E06_14 and E06_15 are members of the E06_14_0 Patient's Age Structure

References in NHTSA Version 141 AgeElement Desirable


DefinitionThe patient's date of birth

Field Values

Data Format [date]E06_16DATE OF BIRTH

Other Associated ElementsPatient Care Report NumberE01_01 Last NameE06_01

References to Other DatabasesEMS Module; Title: Date of Birth; The date of birth of the patient in MMDDYYYY format.● NFIRS 5.0


UsesKey component of an EMS Medical Record● Provides important information which will allow EMS data to be sorted, grouped and evaluated by age demographics●


DateOfBirthXSD Domain (Simple Type)XSD Data Type xs:date




References in NHTSA Version 140 Date of BirthElement Essential


DefinitionThe primary method of payment or type of insurance associated with this EMS encounter

Field Values

National ElementData Format [combo] single-choiceE07_01PRIMARY METHOD OF PAYMENT


Not Applicable-25 Not Known-10Not Available-5 Insurance720Medicaid725 Medicare730Not Billed (for any reason)735 Other Government740Self Pay745 Workers Compensation750

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on the payer mix● Allows data to describe the EMS patient population's payer mix●


PrimaryMethodOfPaymentXSD Domain (Simple Type)XSD Data Type xs:integer



Section E07 Billing Page 192 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionIndication of whether a certificate of medical necessity is present

Field Values

Data Format [combo] single-choiceE07_02CERTIFICATE OF MEDICAL NECESSITY


Not Applicable-25 Not Known-10Not Available-5 No0Yes1

UsesKey component of an EMS Medical Record for billing of some patient transports●


YesNoValuesXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe ID number of the patient's insurance company

Field Values

Data Format [text]E07_03INSURANCE COMPANY ID/NAME

Additional InformationMultiple entry configuration required to allow more than one insurance company●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Insurance Company Billing PriorityE07_04Insurance Company AddressE07_05 Insurance Company CityE07_06Insurance Company StateE07_07 Insurance Company Zip CodeE07_08Insurance Group ID/NameE07_09 Insurance Policy ID NumberE07_10Last Name of the InsuredE07_11 First Name of the InsuredE07_12Middle Initial/Name of the InsuredE07_13 Relationship to the InsuredE07_14


UsesKey component of an EMS Medical Record for billing ●


InsuranceCompanyIDXSD Domain (Simple Type)XSD Data Type xs:string



2 30XSD Structure: (1) E07_03, E07_05, E07_05, E07_06, E07_07, E07_08, E07_09, E07_10, E07_11, E07_12, E07_13, E07_14 are all members of E03 Insurance Structure. (2) E07_05, E07_06, E07_07, and E07_08 are all members of E07_05_0 Insurance Company Address Structure. (3) E07_11, E07_12, E07_13 are all members of E07_11_0 Insured Name Structure



DefinitionThe billing priority or order for the insurance company.

Field Values

Data Format [combo] single-choiceE07_04INSURANCE COMPANY BILLING PRIORITY

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Insurance Company ID/NameE07_03 Insurance Company AddressE07_05Insurance Company CityE07_06 Insurance Company StateE07_07Insurance Company Zip CodeE07_08 Insurance Group ID/NameE07_09Insurance Policy ID NumberE07_10 Last Name of the InsuredE07_11First Name of the InsuredE07_12 Middle Initial/Name of the InsuredE07_13Relationship to the InsuredE07_14

Not Applicable-25 Not Known-10Not Available-5 Primary755Secondary760 Other765



InsuranceCompanyBillingPriorityXSD Domain (Simple Type)XSD Data Type xs:integer



XSD Structure: (1) E07_03, E07_05, E07_05, E07_06, E07_07, E07_08, E07_09, E07_10, E07_11, E07_12, E07_13, E07_14 are all members of E03 Insurance Structure. (2) E07_05, E07_06, E07_07, and E07_08 are all members of E07_05_0 Insurance Company Address Structure. (3) E07_11, E07_12, E07_13 are all members of E07_11_0 Insured Name Structure


DefinitionThe mailing address of the Insurance Company

Field Values

Data Format [text]E07_05INSURANCE COMPANY ADDRESS

Additional InformationE07_05, E07_06, D07_07 and D07_08 are members of the Insurance Address group●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Insurance Company ID/NameE07_03Insurance Company Billing PriorityE07_04 Insurance Company CityE07_06Insurance Company StateE07_07 Insurance Company Zip CodeE07_08Insurance Group ID/NameE07_09 Insurance Policy ID NumberE07_10Last Name of the InsuredE07_11 First Name of the InsuredE07_12Middle Initial/Name of the InsuredE07_13 Relationship to the InsuredE07_14










DefinitionThe insurance companies city or township

Field Values

Data Format [combo] single-choiceE07_06INSURANCE COMPANY CITY

Additional Information5 digit FIPS Code● Could be filled in from Insurance Company Zip Code (E07_08)● E07_05, E07_06, D07_07 and D07_08 are members of the Insurance Address group●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Insurance Company ID/NameE07_03Insurance Company Billing PriorityE07_04 Insurance Company AddressE07_05Insurance Company StateE07_07 Insurance Company Zip CodeE07_08Insurance Group ID/NameE07_09 Insurance Policy ID NumberE07_10Last Name of the InsuredE07_11 First Name of the InsuredE07_12Middle Initial/Name of the InsuredE07_13 Relationship to the InsuredE07_14










DefinitionThe insurance companies state, territory, or province, or District of Columbia.

Field Values

Data Format [combo] single-choiceE07_07INSURANCE COMPANY STATE

Additional Information2 digit FIPS Code● Could be filled in from Insurance Company Zip Code (E07_08)● E07_05, E07_06, D07_07 and D07_08 are members of the Insurance Address group●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Insurance Company ID/NameE07_03Insurance Company Billing PriorityE07_04 Insurance Company AddressE07_05Insurance Company CityE07_06 Insurance Company Zip CodeE07_08Insurance Group ID/NameE07_09 Insurance Policy ID NumberE07_10Last Name of the InsuredE07_11 First Name of the InsuredE07_12Middle Initial/Name of the InsuredE07_13 Relationship to the InsuredE07_14










DefinitionThe insurance companies Zip Code

Field Values

Data Format [text]E07_08INSURANCE COMPANY ZIP CODE

Additional InformationCan be a 5 or 9 digit Zip Code● E07_05, E07_06, D07_07 and D07_08 are members of the Insurance Address group●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Insurance Company ID/NameE07_03Insurance Company Billing PriorityE07_04 Insurance Company AddressE07_05Insurance Company CityE07_06 Insurance Company StateE07_07Insurance Group ID/NameE07_09 Insurance Policy ID NumberE07_10Last Name of the InsuredE07_11 First Name of the InsuredE07_12Middle Initial/Name of the InsuredE07_13 Relationship to the InsuredE07_14



Data CollectorEMS personnel unless the EMS Agency has professional billing personnel to provide this function●







DefinitionThe ID number or name of the patient's insurance group

Field Values

Data Format [text]E07_09INSURANCE GROUP ID/NAME

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Insurance Company ID/NameE07_03Insurance Company Billing PriorityE07_04 Insurance Company AddressE07_05Insurance Company CityE07_06 Insurance Company StateE07_07Insurance Company Zip CodeE07_08 Insurance Policy ID NumberE07_10Last Name of the InsuredE07_11 First Name of the InsuredE07_12Middle Initial/Name of the InsuredE07_13 Relationship to the InsuredE07_14




InsuranceGroupIDNameXSD Domain (Simple Type)XSD Data Type xs:string






DefinitionThe ID number of the patient's insurance policy

Field Values

Data Format [text]E07_10INSURANCE POLICY ID NUMBER

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Insurance Company ID/NameE07_03 Insurance Company Billing PriorityE07_04Insurance Company AddressE07_05 Insurance Company CityE07_06Insurance Company StateE07_07 Insurance Company Zip CodeE07_08Insurance Group ID/NameE07_09 Last Name of the InsuredE07_11First Name of the InsuredE07_12 Middle Initial/Name of the InsuredE07_13Relationship to the InsuredE07_14




InsurancePolicyIDNumberXSD Domain (Simple Type)XSD Data Type xs:string






DefinitionThe last (family) name of the person insured by the insurance company.

Field Values

Data Format [text]E07_11LAST NAME OF THE INSURED

Additional InformationE07_11, E07_12, and D07_13 are members of the Name of Insured group●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Insurance Company ID/NameE07_03Insurance Company Billing PriorityE07_04 Insurance Company AddressE07_05Insurance Company CityE07_06 Insurance Company StateE07_07Insurance Company Zip CodeE07_08 Insurance Group ID/NameE07_09Insurance Policy ID NumberE07_10 First Name of the InsuredE07_12Middle Initial/Name of the InsuredE07_13 Relationship to the InsuredE07_14










DefinitionThe first (given) name of the person insured by the insurance company

Field Values

Data Format [text]E07_12FIRST NAME OF THE INSURED


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Insurance Company ID/NameE07_03Insurance Company Billing PriorityE07_04 Insurance Company AddressE07_05Insurance Company CityE07_06 Insurance Company StateE07_07Insurance Company Zip CodeE07_08 Insurance Group ID/NameE07_09Insurance Policy ID NumberE07_10 Last Name of the InsuredE07_11Last Name of the InsuredE07_11 Middle Initial/Name of the InsuredE07_13Relationship to the InsuredE07_14










DefinitionThe middle name, if any, of the person insured by the insurance company.

Field Values

Data Format [text]E07_13MIDDLE INITIAL/NAME OF THE INSURED


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Insurance Company ID/NameE07_03 Insurance Company Billing PriorityE07_04Insurance Company AddressE07_05 Insurance Company CityE07_06Insurance Company StateE07_07 Insurance Company Zip CodeE07_08Insurance Group ID/NameE07_09 Insurance Policy ID NumberE07_10Last Name of the InsuredE07_11 Last Name of the InsuredE07_11First Name of the InsuredE07_12 First Name of the InsuredE07_12Relationship to the InsuredE07_14










DefinitionThe relationship of the patient to the primary insured person

Field Values

Data Format [combo] single-choiceE07_14RELATIONSHIP TO THE INSURED

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Insurance Company ID/NameE07_03 Insurance Company Billing PriorityE07_04Insurance Company AddressE07_05 Insurance Company CityE07_06Insurance Company StateE07_07 Insurance Company Zip CodeE07_08Insurance Group ID/NameE07_09 Insurance Policy ID NumberE07_10Last Name of the InsuredE07_11 First Name of the InsuredE07_12Middle Initial/Name of the InsuredE07_13

Not Applicable-25 Not Known-10Not Available-5 Self770Spouse775 Son/Daughter780Other785



RelationshipToInsuredXSD Domain (Simple Type)XSD Data Type xs:integer



XSD Structure: (1) E07_03, E07_05, E07_05, E07_06, E07_07, E07_08, E07_09, E07_10, E07_11, E07_12, E07_13, E07_14 are all members of E03 Insurance Structure. (2) E07_05, E07_06, E07_07, and E07_08 are all members of E07_05_0 Insurance Company Address Structure. (3) E07_11, E07_12, E07_13 are all members of E07_11_0 Insured Name Structure


DefinitionIndication of whether or not the injury is work related.

Field Values

Data Format [combo] single-choiceE07_15WORK-RELATED

Additional InformationIf work related this data point is associated with Patient's Occupational Industry (E07_16) and Patient's Occupation (E07_17)

●



UsesCan be used to better describe injuries along with the Injury specific data● Key component of an EMS Medical Record for billing ●






DefinitionThe occupational industry of the patient’s work

Field Values

Data Format [combo] single-choiceE07_16PATIENT’S OCCUPATIONAL INDUSTRY

Additional InformationRecorded if Work Related (E07_15) also with Patient's Occupation (E07_17)● US Bureau of Labor Statistics Industry Classification●


Not Applicable-25 Not Known-10Not Available-5 Construction790Finance, Insurance, and Real Estate795 Government800Manufacturing805 Mining810Retail Trade815 Services820Transportation and Public Utilities825 Wholesale Trade830



PatientsOccupationalIndustryXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe occupation of the patient

Field Values

Data Format [combo] single-choiceE07_17PATIENT’S OCCUPATION

Additional Information1999 US Bureau of Labor Statistics Standard Occupational Classification (SOC)● Recorded if Work Related (E07_15) also with Patient's Occupational Industry (E07_16)●


Not Applicable-25 Not Known-10Not Available-5 Management Occupations835Business and Financial Operations Occupations840 Computer and Mathematical Occupations845Architecture and Engineering Occupations850 Life, Physical, and Social Science Occupations855Community and Social Services Occupations860 Legal Occupations865Education, Training, and Library Occupations870 Arts, Design, Entertainment, Sports, and Media

Occupations875

Healthcare Practitioners and Technical Occupations880 Healthcare Support Occupations885Protective Service Occupations890 Food Preparation and Serving Related Occupations895Building and Grounds Cleaning and Maintenance Occupations

900 Personal Care and Service Occupations905

Sales and Related Occupations910 Office and Administrative Support Occupations915Farming, Fishing and Forestry Occupations920 Construction and Extraction Occupations925Installation, Maintenance, and Repair Occupations930 Production Occupations935Transportation and Material Moving Occupations940 Military Specific Occupations945



PatientsOccupationXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe last (family) name of the patient's closest relative or guardian

Field Values

Data Format [text]E07_18CLOSEST RELATIVE/GUARDIAN LAST NAME

Additional InformationThe Closest Relataive/Gardian Name group includes E07_18, E07_19, and E07_20●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 First Name of the Closest Relative/

GuardianE07_19

Middle Initial/Name of the Closest Relative/ Guardian

E07_20


UsesKey component of an EMS Medical Record for contact information associated with billing● Key component of an EMS Medical Record if the patient is a minor●





2 20XSD Structure: E07_18, E07_19, and E07_20 are all members of E07_18_01 Closest Relative Structure



DefinitionThe first (given) name of the patient's closest relative or guardian

Field Values

Data Format [text]E07_19FIRST NAME OF THE CLOSEST RELATIVE/ GUARDIAN


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Closest Relative/Guardian Last NameE07_18Middle Initial/Name of the Closest Relative/ Guardian

E07_20










DefinitionThe middle name/initial, if any, of the closest relative or guardian.

Field Values

Data Format [text]E07_20MIDDLE INITIAL/NAME OF THE CLOSEST RELATIVE/ GUARDIAN


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Closest Relative/Guardian Last NameE07_18First Name of the Closest Relative/ Guardian

E07_19










DefinitionThe home street address of the patient's closest relative or guardian

Field Values

Data Format [text]E07_21CLOSEST RELATIVE/ GUARDIAN STREET ADDRESS

Additional InformationThe Closest Relataive/Gardian Address group includes E07_21, E07_22, E07_23, and E07_24●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Closest Relative/Guardian Last NameE07_18Closest Relative/ Guardian CityE07_22 Closest Relative/ Guardian StateE07_23Closest Relative/ Guardian Zip CodeE07_24







2 30XSD Structure: E07_21, E07_22, E07_23, E07_24 are all members of E07_21_0 Closest Relatives Address Structure



DefinitionThe home city of the patient's closest relative or guardian

Field Values

Data Format [combo] single-choiceE07_22CLOSEST RELATIVE/ GUARDIAN CITY

Additional Information5 digit FIPS Code● Could be filled in from Closest Relative/Guardian Zip Code (E07_24)● The Closest Relataive/Gardian Address group includes E07_21, E07_22, E07_23, and E07_24●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Closest Relative/Guardian Last NameE07_18Closest Relative/ Guardian Street AddressE07_21 Closest Relative/ Guardian StateE07_23Closest Relative/ Guardian Zip CodeE07_24










DefinitionThe home state of the patient's closest relative or guardian

Field Values

Data Format [combo] single-choiceE07_23CLOSEST RELATIVE/ GUARDIAN STATE

Additional Information2 digit FIPS Code● Could be filled in from Closest Relative/Guardian Zip Code (E07_24)● The Closest Relataive/Gardian Address group includes E07_21, E07_22, E07_23, and E07_24●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Closest Relative/Guardian Last NameE07_18Closest Relative/ Guardian Street AddressE07_21 Closest Relative/ Guardian CityE07_22Closest Relative/ Guardian Zip CodeE07_24










DefinitionThe home Zip Code of the patient's closest relative or guardian

Field Values

Data Format [text]E07_24CLOSEST RELATIVE/ GUARDIAN ZIP CODE

Additional InformationCan be a 5 or 9 digit Zip Code● The Closest Relataive/Gardian Address group includes E07_21, E07_22, E07_23, and E07_24●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Closest Relative/Guardian Last NameE07_18Closest Relative/ Guardian Street AddressE07_21 Closest Relative/ Guardian CityE07_22Closest Relative/ Guardian StateE07_23










DefinitionThe home or other phone number of the patient's closest relative or guardian

Field Values

Data Format [number]E07_25CLOSEST RELATIVE/ GUARDIAN PHONE NUMBER

Additional Information10 digit telephone number●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Closest Relative/Guardian Last NameE07_18




TelephoneNumberXSD Domain (Simple Type)XSD Data Type xs:string





DefinitionThe relationship of the patient's closest relative or guardian

Field Values

Data Format [combo] single-choiceE07_26CLOSEST RELATIVE/ GUARDIAN RELATIONSHIP

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Last NameE06_01 Closest Relative/Guardian Last NameE07_18

Not Applicable-25 Not Known-10Not Available-5 Appointed Guardian950Father955 Mother960Other965 Son/Daughter970Spouse975



ClosestRelativeGuardianRelationshipXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe CMS service level for this EMS encounter.

Field Values

National ElementData Format [combo] single-choiceE07_34CMS SERVICE LEVEL


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5BLS990 BLS, Emergency995ALS, Level 11000 ALS, Level 1 Emergency1005ALS, Level 21010 Paramedic Intercept1015Specialty Care Transport1020 Fixed Wind (Airplane)1025Rotary Wing (Helicopter)1030

UsesAllows data to be quantified and described based on the CMS Service Level● Allows data to be sorted based on the CMS Service Level● Important for EMS billing●


CMSServiceLevelXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe condition codes are used to better describe the service and patient care delivery by an EMS service. Please consult CMS documentation for detailed descriptions of these condition codes and their use.

Field Values

National ElementData Format [combo] multiple-choiceE07_35CONDITION CODE NUMBER

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Severe Abdominal Pain (ALS-789.00)8001 Abdominal Pain (ALS-789.00)8002Abnormal Cardiac Rhythm/Cardiac Dysrhythmia (ALS-427.9)

8003 Abnormal Skin Signs (ALS-780.8)8004

Abnormal Vital Signs (ALS-796.4)8005 Allergic Reaction (ALS-995.0)8006Allergic Reaction (BLS-692.9)8007 Blood Glucose (ALS-790.21)8008Respiratory Arrest (ALS-799.1)8009 Difficulty Breathing (ALS-786.05)8010Cardiac Arrest-Resuscitation in Progress (ALS-427.5)8011 Chest Pain (non-traumatic) (ALS-786.50)8012Choking Episode (ALS-784.9)8013 Cold Exposure (ALS-991.6)8014Cold Exposure (BLS-991.9)8015 Altered Level of Consciousness (non-traumatic) (ALS-

780.01)8016

Convulsions/Seizures (ALS-780.39)8017 Eye Symptoms (non-traumatic) (BLS-379.90)8018Non Traumatic Headache (ALS-437.9)8019 Cardiac Symptoms other than Chest Pain (palpitations)

(ALS-785.1)8020

Cardiac Symptoms other than Chest Pain (atypical pain) (ALS-536.2)

8021 Heat Exposure (ALS-992.5)8022

Heat Exposure (BLS-992.2)8023 Hemorrhage (ALS-459.0)8024Infectious Diseases requiring Isolation/Public Health Risk (BLS-038.9)

8025 Hazmat Exposure (ALS-987.9)8026

Medical Device Failure (ALS-996.0)8027 Medical Device Failure (BLS-996.3)8028Neurologic Distress (ALS-436.0)8029 Pain (Severe) (ALS-780.99)8030Back Pain (non-traumatic possible cardiac or vascular) (ALS-724.5)

8031 Back Pain (non-traumatic with neurologic symptoms) (ALS-724.9)

8032

Poisons (all routes) (ALS-977.9)8033 Alcohol Intoxication or Drug Overdose (BLS-305.0)8034Severe Alcohol Intoxication (ALS-977.3)8035 Post-Operative Procedure Complications (BLS-998.9)8036Pregnancy Complication/Childbirth/Labor (ALS-650.0)8037 Psychiatric/Behavioral (abnormal mental status) (ALS-

292.9)8038

Psychiatric/Behavioral (threat to self or others) (BLS-298.9)

8039 Sick Person-Fever (BLS-036.9)8040

Severe Dehydration (ALS-787.01)8041 Unconscious/Syncope/Dizziness (ALS-780.02)8042Major Trauma (ALS-959.8)8043 Other Trauma (need for monitor or airway) (ALS-518.5)8044Other Trauma (major bleeding) (ALS-958.2)8045 Other Trauma (fracture/dislocation) (BLS-829.0)8046Other Trauma (penetrating extremity) (BLS-880.0)8047 Other Trauma (amputation digits) (BLS-886.0)8048Other Trauma (amputation other) (ALS-887.4)8049 Other Trauma (suspected internal injuries) (ALS-869.0)8050Burns-Major (ALS-949.3)8051 Burns-Minor (BLS-949.2)8052Animal Bites/Sting/Envenomation (ALS-989.5)8053 Animal Bites/Sting/Envenomation (BLS-879.8)8054Lightning (ALS-994.0)8055 Electrocution (ALS-994.8)8056

ConditionCodeNumberXSD Domain (Simple Type)XSD Data Type xs:string



2 30XSD Structure: E07_35, E07_36 are members of E07_35_0 Condition Codes Structure



Additional InformationA list of 95 Condition Codes which are mapped to ICD-9 Codes. At this time the Condition Code List is still in draft. The number of the Condition Code should be stored in this field

●

From the Center for Medicare and Medicaid Services (CMS) Ambulance Fee Schedule Condition Based Coding●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01ICD-9 Code for the Condition Code NumberE07_36 Condition Code ModifierE07_37

Near Drowning (ALS-994.1)8057 Eye Injuries (BLS-921.9)8058Sexual Assault (major injuries) (ALS-995.83)8059 Sexual Assault (minor injuries) (BLS-995.8)8060Cardiac/Hemodynamic Monitoring Required (ALS-428.9)8061 Advanced Airway Management (ALS-518.81)8062IV Meds Required (ALS-No ICD code provided))8063 Chemical Restraint (ALS-293.0)8064Suctioning/Oxygen/IV fluids required (BLS-496.0)8065 Airway Control/Positioning Required (BLS-786.09)8066Third Party Assistance/Attendant Required (BLS-496.0)8067 Patient Safety (restraints required) (BLS-298.9)8068Patient Safety (monitoring required) (BLS-293.1)8069 Patient Safety (seclusion required) (BLS-298.8)8070Patient Safety (risk of falling off stretcher) (BLS-781.3)8071 Special Handling (Isolation) (BLS-041.9)8072Special Handling (orthopedic device required) (BLS-907.2)

8073 Special Handling (positioning required) (BLS-719.45)8074

UsesAllows data to be quantified and described based on the Condition Code● Allows data to be sorted based on the Condition Code● Important for EMS billing●



DefinitionIndicator of how many total patients were at the scene

Field Values

National ElementData Format [combo] single-choiceE08_05NUMBER OF PATIENTS AT SCENE


References to Other DatabasesEMS Module; Title: Number of Patients; The total number of patients.● NFIRS 5.0

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5None1120 Single1125Multiple1130

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on the number of patients associated with the event and resources required● Allows data to describe the number of EMS events with multiple patient encounters●


NumberOfPatientsAtSceneXSD Domain (Simple Type)XSD Data Type xs:integer



Section E08 Scene Page 235 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionIndicator if this event would be considered a mass casualty incident (overwhelmed existing EMS resources)

Field Values

National ElementData Format [combo] single-choiceE08_06MASS CASUALTY INCIDENT


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5No0 Yes1

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on a Mass Casualty Event● Allows data to describe the number of EMS events which were declared a mass casualty event and is connected with disaster and domestic preparedness

●






DefinitionThe kind of location where the incident happened

Field Values

National ElementData Format [combo] single-choiceE08_07INCIDENT LOCATION TYPE

Additional InformationBased on ICD-9●


References to Other DatabasesTitle: Location of Arrest: Out of Hospital; Same as NHTSA E-Codes● UTSTEIN

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Home/Residence1135 Farm1140Mine or Quarry1145 Industrial Place and Premises1150Place of Recreation or Sport1155 Street or Highway1160Public Building (schools, gov. offices)1165 Trade or service (business, bars, restaurants, etc)1170Health Care Facility (clinic, hospital, nursing home)1175 Residential Institution (Nursing Home, jail/prison)1180Lake, River, Ocean1185 Other Location1190

UsesA 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●


IncidentLocationTypeXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 105 Location TypeElement Essential


DefinitionThe street address (or best approximation) where the patient was found, or, if no patient, the address to which the unit responded.

Field Values

Data Format [text]E08_11INCIDENT ADDRESS

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Incident Location TypeE08_07 Incident CityE08_12Incident StateE08_14 Incident ZIP CodeE08_15


UsesA 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

●






2 30XSD Structure: E08_11, E08_12, E08_14, E08_15 are all members of E08_11_0 Incident Address Structure


References in NHTSA Version 101 Incident AddressElement Essential


DefinitionThe city or township (if applicable) where the patient was found or to which the unit responded (or best approximation)

Field Values

Data Format [combo] single-choiceE08_12INCIDENT CITY

Additional Information5 digit FIPS Code● Could be filled in from Incident Zip Code entry (E08_15)●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Incident Location TypeE08_07 Incident AddressE08_11Incident StateE08_14 Incident ZIP CodeE08_15



●








References in NHTSA Version 102 Incident CityElement Essential


DefinitionThe county or parish where the patient was found or to which the unit responded (or best approximation)

Field Values

Data Format [combo] single-choiceE08_13INCIDENT COUNTY

Additional InformationCould 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 ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Incident Location TypeE08_07



●



CountyXSD Domain (Simple Type)XSD Data Type xs:string




References in NHTSA Version 103 Incident CountyElement Essential


DefinitionThe state, territory, or province where the patient was found or to which the unit responded (or best approximation)

Field Values

Data Format [combo] single-choiceE08_14INCIDENT STATE

Additional Information2 digit FIPS code● Could be filled in from Incident Zip Code entry (E08_15)●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Incident Location TypeE08_07 Incident AddressE08_11Incident CityE08_12 Incident ZIP CodeE08_15

References to Other DatabasesBasic Module 1; Title: State; 2 digit FIPS; Text Field Size = 2● NFIRS 5.0



●








References in NHTSA Version 104 Incident StateElement Essential


DefinitionThe ZIP code of the incident location

Field Values

National ElementData Format [text]E08_15INCIDENT ZIP CODE

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Incident Location TypeE08_07 Incident AddressE08_11Incident CityE08_12 Incident StateE08_14


UsesA 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●








DefinitionAny care which was provided to the patient prior to the arrival of this unit.

Field Values

National ElementData Format [combo] multiple-choiceE09_01PRIOR AID

Additional InformationList created from Procedures (D04_04) and Medications (D04_06)●


References to Other DatabasesEMS Module; Title: Cardiac Arrest; Pick-List: Pre-Arrival Arrest = 1, Post-Arrival Arrest = 2;● NFIRS 5.0

EMS Module; Title: Pre-Arrival Details; Pick-List: Witnessed = 1, Bystander CPR = 2● NFIRS 5.0

Title: CPR Before EMS and Rhythm Analysis or Defibrillation before EMS; [combo] Yes = Y, No = No, U = Unknown

● UTSTEIN


UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on the specific prior aid received or not received by the patient● Allows data to describe aid which was provided prior to EMS arrival● Used as a Quality Management tool to evaluate Bystander and First Responder involvement●


PriorAidXSD Domain (Simple Type)XSD Data Type xs:string




References in NHTSA Version 158 Time of First CPRElement Desirable

Section E09 Situation Page 247 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe type of individual who performed the care prior to the arrival of this unit.

Field Values

National ElementData Format [combo] multiple-choiceE09_02PRIOR AID PERFORMED BY


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5EMS Provider1195 Law Enforcement1200Lay Person1205 Other Healthcare Provider1210Patient1215

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on who provided specific prior aid● Allows data to describe who performed any aid which was provide prior to EMS arrival to the patient● Used as a Quality Management tool to evaluate Bystander and First Responder involvement●


PriorAidPerformedByXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionWhat was the outcome or result of the care performed prior to the arrival of the unit?

Field Values

National ElementData Format [combo] single-choiceE09_03OUTCOME OF THE PRIOR AID


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Improved1220 Unchanged1225Worse1230

UsesAllows data to be sorted based on the perceived outcome which resulted from specific prior aid received by the patient● Allows data to describe aid which was provided prior to EMS arrival● Used as a Quality Management tool to evaluate Bystander and First Responder involvement●


OutcomeOfPriorAidXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionIndicates that the reason for the EMS encounter was related to an injury or traumatic event. This data element provides documentation to classify the EMS Reason for Encounter as either injury or non-injury related based on mechanism and not on actual injury

Field Values

National ElementData Format [combo] single-choiceE09_04POSSIBLE INJURY

Additional InformationCan be used to determine which records should have Section E10: Situation/ Trauma completed. If Injury Present (E09_04) is “Yes”, Section E10 should be completed

●

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

●



UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on trauma vs. non-traumatic events● Allows data to describe trauma within the EMS patient population● Allows for the calculation of the "EMS Reason for Encounter" used to further describe the EMS patient population●






DefinitionThe statement of the problem by the patient or the history provider in one or two words

Field Values

Data Format [text]E09_05CHIEF COMPLAINT



UsesAllows 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●


ChiefComplaintNarrativeXSD Domain (Simple Type)XSD Data Type xs:string




References in NHTSA Version 148 Chief ComplaintElement Desirable


DefinitionThe time duration of the chief complaint

Field Values

Data Format [number]E09_06DURATION OF CHIEF COMPLAINT

Other Associated ElementsPatient Care Report NumberE01_01 Chief ComplaintE09_05Time Units of Duration of Chief ComplaintE09_07


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

●


DurationOfChiefComplaintXSD Domain (Simple Type)XSD Data Type xs:integer



1 360XSD Structure: E09_06 and E09_07 are members of E09_06_0 Duration of Chief Complaint Structure



DefinitionThe time units of the duration of the patient's chief complaint

Field Values

Data Format [combo] single-choiceE09_07TIME UNITS OF DURATION OF CHIEF COMPLAINT

Other Associated ElementsPatient Care Report NumberE01_01 Chief ComplaintE09_05Duration of Chief ComplaintE09_06

Seconds1235 Minutes1240Hours1245 Days1250Weeks1255 Months1260Years1265 Relevant Value for Data Element & Patient Care●

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

●


TimeUnitsOfChiefComplaintXSD Domain (Simple Type)XSD Data Type xs:integer



XSD Structure: E09_06 and E09_07 are members of E09_06_0 Duration of Chief Complaint Structure


DefinitionThe primary anatomic location of the chief complaint as identified by EMS personnel

Field Values

National ElementData Format [combo] single-choiceE09_11CHIEF COMPLAINT ANATOMIC LOCATION

Additional InformationPossible 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

●


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Abdomen1305 Back1310Chest1315 Extremity-Lower1320Extremity-Upper1325 General/Global1330Genitalia1335 Head1340Neck1345

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


ComplaintAnatomicLocationXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe primary organ system of the patient injured or medically affected. This is to be completed by EMS personnel with a minimum of an EMT-Paramedic level of credentialing.

Field Values

National ElementData Format [combo] single-choiceE09_12CHIEF COMPLAINT ORGAN SYSTEM


●

This data element is to be completed by EMS personnel at the EMT-Paramedic level or higher●


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Cardiovascular1350 CNS/Nero1355Endocrine/Metabolic1360 GI1365Global1370 Musculoskeletal1375OB/Gyn1380 Psych1385Pulmonary1390 Renal1395Skin1400

UsesA component of the EMS Medical Record: Patient Care Report● Allows for the calculation of the "EMS Reason for Encounter" used to further describe the EMS patient population●


ComplaintOrganSystemXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe primary sign and symptom present in the patient or observed by EMS personnel

Field Values

National ElementData Format [combo] single-choiceE09_13PRIMARY SYMPTOM


●


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Bleeding1405 Breathing Problem1410Change in responsiveness1415 Choking1420Death1425 Device/Equipment Problem1430Diarrhea1435 Drainage/Discharge1440Fever1445 Malaise1450Mass/Lesion1455 Mental/Psych1460Nausea/Vomiting1465 None1470Pain1475 Palpitations1480Rash/Itching1485 Swelling1490Transport Only1495 Weakness1500Wound1505

UsesA 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●


PrimarySymptomXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 152 Signs and Symptoms PresentElement Essential


DefinitionOther symptoms identified by the patient or observed by EMS personnel

Field Values

National ElementData Format [combo] multiple-choiceE09_14OTHER ASSOCIATED SYMPTOMS

Additional InformationThis data element is used for Bioterrorism Syndromic Surveillance●


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Bleeding1405 Breathing Problem1410Change in responsiveness1415 Choking1420Death1425 Device/Equipment Problem1430Diarrhea1435 Drainage/Discharge1440Fever1445 Malaise1450Mass/Lesion1455 Mental/Psych1460Nausea/Vomiting1465 None1470Pain1475 Palpitations1480Rash/Itching1485 Swelling1490Transport Only1495 Weakness1500Wound1505

UsesA 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

●


OtherAssociatedSymptomsXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 152 Signs and Symptoms PresentElement Essential


DefinitionThe EMS personnel’s impression of the patient’s primary problem or most significant condition which led to the management given to the patient (treatments, medications, or procedures).

Field Values

National ElementData Format [combo] single-choiceE09_15PROVIDERS PRIMARY IMPRESSION

Additional InformationICD-9 Codes were retained over ICD-10 due to CMS’s continued use of ICD-9 in the EMS Condition Codes●


References to Other DatabasesEMS Module; Title: Provider Impression/Assessment; The emergency providers single most important impression/assessment which drove the choice of treatment; [combo] Abdominal Pain = 10, Airway Obstruction = 11, Allergic Reaction, excludes stings & venomous bites = 12, Altered Level of Consciousness = 13, Behavioral-Mental Status, Psychiatric Disorder = 14, Burns = 15, Cardiac Arrest = 16, Cardiac Dysrhythmia = 17, Chest Paid = 18, Diabetic Symptom = 19, Do Not Resuscitate = 20, Electrocution = 21, General Illness = 2, Hemorrhaging/Bleeding = 23, Hyperthermia = 24, Hypothermia = 25, Hypovolemia = 26, Inhalation Injury, Toxic Gases = 27, Obvious Death = 28, Overdose/Poisoning = 29, Pregnancy/OB = 30, Respiratory Arrest = 31, Respiratory Distress = 32, Seizure = 33, Sexual Assault = 34, Sting/Bite = 35, Stroke/CVA = 36, Syncope, Fainting = 37, Trauma = 38, Other

● NFIRS 5.0

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5789.00- Abdominal pain / problems1615 519.80- Airway obstruction1620995.30- Allergic reaction1625 780.09- Altered level of consciousness1630312.90- Behavioral / psychiatric disorder1635 427.50- Cardiac arrest1640427.90- Cardiac rhythm disturbance1645 786.50- Chest pain / discomfort1650250.90- Diabetic symptoms (hypoglycemia)1655 994.80- Electrocution1660780.60- Hyperthermia1665 780.90- Hypothermia1670785.59- Hypovolemia / shock1675 987.90- Inhalation injury (toxic gas)1680798.99- Obvious death1685 977.90- Poisoning / drug ingestion1690659.90- Pregnancy / OB delivery1695 786.09- Respiratory distress1700799.10- Respiratory arrest1705 780.30- Seizure1710959.90- Sexual assault / rape1715 987.90- Smoke inhalation1720989.50- Stings / venomous bites1725 436.00- Stroke / CVA1730780.20- Syncope / fainting1735 959.90- Traumatic injury1740623.80- Vaginal hemorrhage1745

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on the EMS personnel's clinical impression● Allows data to describe the EMS patient population based on EMS personnel impression of the EMS patient's problem●


ProvidersPrimaryImpressionXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 150 Providers ImpressionElement Essential


Impression/Assessment = 00, None/No patient or refused Treatment = NN


DefinitionThe EMS personnel’s impression of the patient’s secondary problem or which led to the management given to the patient (treatments, medications, or procedures).

Field Values

National ElementData Format [combo] single-choiceE09_16PROVIDER’S SECONDARY IMPRESSION


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5789.00- Abdominal pain / problems1750 519.80- Airway obstruction1755995.30- Allergic reaction1760 780.09- Altered level of consciousness1765312.90- Behavioral / psychiatric disorder1770 427.50- Cardiac arrest1775427.90- Cardiac rhythm disturbance1780 786.50- Chest pain / discomfort1785250.90- Diabetic symptoms (hypoglycemia)1790 994.80- Electrocution1795780.60- Hyperthermia1800 780.90- Hypothermia1805785.59- Hypovolemia / shock1810 987.90- Inhalation injury (toxic gas)1815798.99- Obvious death1820 977.90- Poisoning / drug ingestion1825659.90- Pregnancy / OB delivery1830 786.09- Respiratory distress1835799.10- Respiratory arrest1840 780.30- Seizure1845959.90- Sexual assault / rape1850 987.90- Smoke inhalation1855989.50- Stings / venomous bites1860 436.00- Stroke / CVA1865780.20- Syncope / fainting1870 959.90- Traumatic injury1875623.80- Vaginal hemorrhage1880

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on the EMS personnel's clinical impression● Allows data to describe the EMS patient population based on EMS personnel impression of the EMS patient's problem●


ProvidersSecondaryImpressionXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 150 Providers ImpressionElement Essential


DefinitionThe category of the reported/suspected external cause of the injury

Field Values

National ElementData Format [combo] single-choiceE10_01CAUSE OF INJURY

Additional InformationComplete 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●


References to Other DatabasesEMS 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

● NFIRS 5.0

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Aircraft related accident (E84X.0)9500 Bicycle Accident (E826.0)9505Bites (E906.0)9510 Chemical poisoning (E86X.0)9515Child battering (E967.0)9520 Drowning (E910.0)9525Drug poisoning (E85X.0)9530 Electrocution (non-lightning) (E925.0)9535Excessive Cold (E901.0)9540 Excessive Heat (E900.0)9545Falls (E88X.0)9550 Fire and Flames (E89X.0)9555Firearm assault (E965.0)9560 Firearm injury (accidental) (E985.0)9565Firearm self inflicted (E955.0)9570 Lightning (E907.0)9575Machinery accidents (E919.0)9580 Mechanical Suffocation (E913.0)9585Motor Vehicle non-traffic accident (E82X.0)9590 Motor Vehicle traffic accident (E81X.0)9595Motorcycle Accident (E81X.1)9600 Non-Motorized Vehicle Accident (E848.0)9605Pedestrian traffic accident (E814.0)9610 Radiation exposure (E926.0)9615Rape (E960.1)9620 Smoke Inhalation (E89X.2)9625Stabbing/Cutting Accidental (E986.0)9630 Stabbing/Cutting Assault (E966.0)9635Struck by Blunt/Thrown Object (E968.2)9640 Venomous stings (plants, animals) (E905.0)9645Water Transport accident (E83X.0)9650

UsesA 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 CollectorEMS personnel if Possible Injury (E09_04) is answered Yes●

CauseOfInjuryXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 149 Cause of InjuryElement Essential

Section E10 Situation/ Trauma Page 265 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

= 31, Physical Assault/Abuse = 32, Scalds/Other Thermal = 33, Smoke Inhalation = 34, Stabbing Assault = 35, Venomous Sting = 36, Water Transport = 37, Other Cause of Injury/Illness = 00, Unknown Cause of Injury/Illness = UU


DefinitionThe intent of the individual inflicting the injury

Field Values

Data Format [combo] single-choiceE10_02INTENT OF THE INJURY

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


References to Other DatabasesEMS Module; Title: Other Factors; Describes the other factors that contributed to the patient’s injury. Not to be completed with an illness.; Pick-List: Accidental = 1, Self-Inflicted = 2, Inflicted, Not Self. Included are attacks by animals and persons = 3, None or No Other Factors = N

● NFIRS 5.0

Not Applicable-25 Not Known-10Not Available-5 Intentional, Other (Assaulted)2020Intentional, Self2025 Unintentional2030

UsesImportant component of an EMS Medical Record: documentation of Intentional, Self● Used to better define injury cause and describe injury patterns within and EMS community●


IntentOfInjuryXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 154 Injury IntentElement Desirable


DefinitionThe mechanism of the event which caused the injury.

Field Values

Data Format [combo] multiple-choiceE10_03MECHANISM OF INJURY



Not Applicable-25 Not Known-10Not Available-5 Blunt2035Burn2040 Other2045Penetrating2050

UsesA 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●


MechanismOfInjuryXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe kind of risk factor predictors associated with the vehicle involved in the incident

Field Values

Data Format [combo] multiple-choiceE10_04VEHICULAR INJURY INDICATORS



Not Applicable-25 Not Known-10Not Available-5 Dash Deformity2055DOA Same Vehicle2060 Ejection2065Fire2070 Rollover/Roof Deformity2075Side Post Deformity2080 Space Intrusion >1 foot2085Steering Wheel Deformity2090 Windshield Spider/Star2095

UsesA component of the EMS Medical Record: Patient Care Report● Used to better define injury cause and describe injury patterns within and EMS community●

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

VehicularInjuryIndicatorsXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe seat row location of the patient in vehicle at the time of the crash with the front seat numbered as 1.

Field Values

Data Format [text]E10_06SEAT ROW LOCATION OF PATIENT IN VEHICLE

Additional InformationComplete only if Possible Injury (E09_04) is “Yes”● Could be configured as a single choice combo box● Numbered to take into account large vehicles such as buses or vans (1 = Front) or (Cargo Area = 50)●

Other Associated ElementsPatient Care Report NumberE01_01 Position of Patient in the Seat of the VehicleE10_07

Relevant Value for Data Element & Patient Care● If a value of 50 is passed, the location is designated "Cargo Area"

●


●



SeatRowLocationXSD Domain (Simple Type)XSD Data Type xs:integer



1 15XSD Structure: E10_06 and E10_07 are members of E10_06_0 Position of Patient Structure



DefinitionThe position of the patient in seat of the vehicle at the time of the crash

Field Values

Data Format [combo] single-choiceE10_07POSITION OF PATIENT IN THE SEAT OF THE VEHICLE


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Seat Row Location of Patient in VehicleE10_06

Not Applicable-25 Not Known-10Not Available-5 Driver2145Left (non-driver)2150 Middle2155Other2160 Right2165


●



PositionOfPatientInSeatXSD Domain (Simple Type)XSD Data Type xs:integer



XSD Structure: E10_06 and E10_07 are members of E10_06_0 Position of Patient Structure


DefinitionSafety equipment in use by the patient at the time of the injury

Field Values

Data Format [combo] multiple-choiceE10_08USE OF OCCUPANT SAFETY EQUIPMENT



References to Other DatabasesEMS 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

● NFIRS 5.0

Not Applicable-25 Not Known-10Not Available-5 Child Restraint2170Eye Protection2175 Helmet Worn2180Lap Belt2185 None2187Other2190 Personal Floatation Device2195Protective Clothing2200 Protective Non-Clothing Gear2205Shoulder Belt2210


●



UseOfOccupantSafetyEquipmentXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 155 Safety EquipmentElement Essential


DefinitionIndication of Airbag deployment during the motor vehicle crash.

Field Values

Data Format [combo] multiple-choiceE10_09AIRBAG DEPLOYMENT



References to Other DatabasesEMS 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

● NFIRS 5.0

Not Applicable-25 Not Known-10Not Available-5 No Airbag Present2215No Airbag Deployed2220 Airbag Deployed Front2225Airbag Deployed Side2230 Airbag Deployed Other (knee, airbelt, etc.)2235


●



AirbagDeploymentXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 155 Safety EquipmentElement Essential


DefinitionThe distance in feet the patient fell, measured from the lowest point of the patient to the ground.

Field Values

Data Format [number]E10_10HEIGHT OF FALL





●



HeightOfFallXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionIndication of the presence of a cardiac arrest at any time associated with the EMS evert.

Field Values

National ElementData Format [combo] single-choiceE11_01CARDIAC ARREST

Additional InformationIf answered YES, all other data points in the Situation/CPR should be addressed●


References to Other DatabasesEMS Module; Title: Cardiac Arrest; Pick-List: Pre-Arrival Arrest = 1, Post-Arrival Arrest = 2● NFIRS 5.0

Title: Confirmed Cardiac Arrests Considered for Resuscitation● UTSTEIN

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5No0 Yes, Prior to EMS Arrival2240Yes, After EMS Arrival2245

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on the occurrence of a cardiac arrest● Allows data to describe the number of cardiac arrests within the EMS patient population●


CardiacArrestXSD Domain (Simple Type)XSD Data Type xs:integer



Section E11 Situation/ CPR Page 277 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionIndication of the etiology or cause of the cardiac arrest (classified as cardiac, non-cardiac, etc.)

Field Values

National ElementData Format [combo] single-choiceE11_02CARDIAC ARREST ETIOLOGY

Additional InformationComplete only if Cardiac Arrest (E11_01) is “Yes”●


References to Other DatabasesTitle: Cardiac Etiology; Presumed Cardiac = C, Trauma = T, Drowning = D, Respiratory = R, Other = O, Unknown = U

● UTSTEIN

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Presumed Cardiac2250 Trauma2255Drowning2260 Respiratory2265Electrocution2270 Other2275

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on the occurrence of a cardiac arrest● Allows data to describe the number of cardiac arrests within the EMS patient population●

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

CardiacArrestEtiologyXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionIndication of an attempt to resuscitate the patient who is in cardiac arrest (attempted, not attempted due to DNR, etc.)

Field Values

National ElementData Format [combo] multiple-choiceE11_03RESUSCITATION ATTEMPTED



References to Other DatabasesTitle: Resuscitations Attempted; Attempted Defibrillation = D, Attempted Chest Compressions = C, Attempted Ventilation = V, Not Attempted-DNR Orders = R, Not Attempted-Considered Futile = F, Not Attempted-Signs of Circulation = A, Unknown = U, Not Record

● UTSTEIN

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Attempted Defibrillation2280 Attempted Ventilation2285Initiated Chest Compressions2290 Not Attempted-Considered Futile2295Not Attempted-DNR Orders2300 Not Attempted-Signs of Circulation2305

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on the type of resuscitation initiated during a cardiac arrest● Allows data to describe the number of cardiac arrests within the EMS patient population which resulted in resuscitative efforts

●


ResucitationAttemptedXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionIndication of who the cardiac arrest was witnessed by

Field Values

Data Format [combo] single-choiceE11_04ARREST WITNESSED BY



References to Other DatabasesEMS Module; Title: Pre-Arrival Details; Pick-List: Witnessed = 1, Bystander CPR = 2● NFIRS 5.0

Title: Arrest Witnessed/Monitored; [combo] Lay Person = L, Healthcare Provider = H● UTSTEIN

Not Applicable-25 Not Known-10Not Available-5 Witnessed by Healthcare Provider2310Witnessed by Lay Person2315 Not Witnessed2320

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on the Witnessed or Un-Witnessed Arrest which is a known key element associated with Cardiac Arrest Outcome

●

Allows data to describe aid which was provided prior to EMS arrival● Used as a Quality Management tool to evaluate Bystander and First Responder involvement●


ArrestWitnessedByXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 162 Witness of Cardiac ArrestElement Desirable


DefinitionIndication whether or not there was any return of spontaneous circulation at any time during the EMS evert.

Field Values

Data Format [combo] single-choiceE11_06ANY RETURN OF SPONTANEOUS CIRCULATION



References to Other DatabasesTitle: Any Return of Spontaneous Circulation (ROSC); [combo] Yes = Y, No = No, U = Unknown● UTSTEIN

Not Applicable-25 Not Known-10Not Available-5 No0Yes, Prior to ED Arrival Only2370 Yes, Prior to ED Arrival and at the ED2375

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on the Return of Spontaneous Circulation associated with a cardiac arrest● Allows for evaluation of Cardiac Arrest data for Quality Improvement of patient care and agency response●


ReturnOfSpontaneousCirculationXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 164 Return of Spontaneous CirculationElement Desirable


DefinitionIndication of whether or not there were any patient specific barriers to serving the patient at the scene

Field Values

National ElementData Format [combo] multiple-choiceE12_01BARRIERS TO PATIENT CARE


References to Other DatabasesEMS Module; Title: Human Factors; Describes the human factors that contributed to the patient’s injury; Pick-List: 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

● NFIRS 5.0

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Developmentally Impaired2600 Hearing Impaired2605Language2610 None2615Physically Impaired2620 Physically Restrained2625Speech Impaired2630 Unattended or Unsupervised (including minors)2635Unconscious2640

UsesA 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●


BarriersToPatientCareXSD Domain (Simple Type)XSD Data Type xs:integer




Section E12 Medical History Page 289 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe patient’s medication allergies

Field Values

Data Format [combo] multiple-choiceE12_08MEDICATION ALLERGIES

Additional InformationA 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●


Not Applicable-25 Not Known-10Not Available-5 Relevant Value for Data Element & Patient Care● NKDA (No Known Drug Allergies)●

UsesPart of an EMS Medical Record●


MedicationAllergiesXSD Domain (Simple Type)XSD Data Type xs:string





DefinitionThe patient’s known allergies to food or environmental agents.

Field Values

Data Format [combo] multiple-choiceE12_09ENVIRONMENTAL/FOOD ALLERGIES


Not Applicable-25 Not Known-10Not Available-5 Insect Sting2675Food Allergy2680 Latex2685Chemical2690 Other2695None2700



EnvironmentalFoodAllergiesXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe patient’s pre-existing medical and surgery history of the patient

Field Values

Data Format [combo or text] multiple-choiceE12_10MEDICAL/SURGICAL HISTORY

Additional InformationA 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

●





MedicalSurgicalHistoryXSD Domain (Simple Type)XSD Data Type xs:string




References in NHTSA Version 151 Pre-Existing ConditionElement Essential


DefinitionThe medications the patient currently takes

Field Values

Data Format [combo or text] multiple-choiceE12_14CURRENT MEDICATIONS

Additional InformationA 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 ElementsPatient Care Report NumberE01_01 Current Medication DoseE12_15Current Medication Dosage UnitE12_16 Current Medication Administration RouteE12_17




CurrentMedicationNameXSD Domain (Simple Type)XSD Data Type xs:string



2 30XSD 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



DefinitionThe numeric dose or amount of the patient’s current medication

Field Values

Data Format [number]E12_15CURRENT MEDICATION DOSE

Other Associated ElementsPatient Care Report NumberE01_01 Current MedicationsE12_14Current Medication Dosage UnitE12_16 Current Medication Administration RouteE12_17




CurrentMedicationDoseXSD Domain (Simple Type)XSD Data Type xs:decimal



0 999999.99XSD 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



DefinitionThe dosage unit of the patient’s current medication

Field Values

Data Format [combo] single-choiceE12_16CURRENT MEDICATION DOSAGE UNIT

Other Associated ElementsPatient Care Report NumberE01_01 Current MedicationsE12_14Current Medication DoseE12_15 Current Medication Administration RouteE12_17

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

GMS2785 Inches2790IU2795 KVO (TKO)2800L/MIN2805 LITERS2810LPM2815 MCG2820MCG/KG/MIN2825 MEQ2830MG2835 MG/KG/MIN2840ML2845 ML/HR2850Other2855 Puffs2860



CurrentMedicationDosageUnitXSD Domain (Simple Type)XSD Data Type xs:integer



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


DefinitionIndicators for the potential use of Alcohol or Drugs by the patient.

Field Values

National ElementData Format [combo] multiple-choiceE12_19ALCOHOL/DRUG USE INDICATORS


References to Other DatabasesEMS Module; Title: Human Factors; Describes the human factors that contributed to the patient’s injury; Pick-List: 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

● NFIRS 5.0

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Smell of Alcohol on Breath2985 Patient Admits to Alcohol Use2990Patient Admits to Drug Use2995 Alcohol and/or Drug Paraphernalia at Scene3000None3001

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on alcohol/drug use indicators● Allows data to describe Alcohol and Drug use within the EMS patient population●


AlcoholDrugUseIndicatorsXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 157 Suspected Alcohol/Drug UseElement Essential


DefinitionThe narrative of the run report

Field Values

Data Format [text]E13_01RUN REPORT NARRATIVE

Additional InformationLarge capacity text field such as a “memo” or equivalent ●




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

●

RunReportNarrativeXSD Domain (Simple Type)XSD Data Type xs:string




Section E13 Narrative Page 310 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionDate/Time Vital Signs Taken

Field Values

Data Format [date/time]E14_01DATE/TIME VITAL SIGNS TAKEN


●

Multiple Entry Configuration to allow multiple sets of Vital Signs●


References to Other DatabasesEMS Module; Title: Patient Pulse; Presence of a Pulse at the time of patient transfer to another service.; Pick-List: Pulse on Transfer = 1, No; Pulse of Transfer = 2

● NFIRS 5.0


UsesPart 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 CollectorEMS personnel or may be provided electronically through a medical device●




1990 2030XSD Structure: Each element is section E14 is associated with a E14_01 Date/Time


Section E14 Assessment/ Vital Signs Page 312 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe initial cardiac rhythm of the patient as interpreted by EMS personnel

Field Values

Data Format [combo] multiple-choiceE14_03CARDIAC RHYTHM

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time Vital Signs TakenE14_01

Not Applicable-25 Not Known-10Not Available-5 12 Lead ECG-Anterior Ischemia300512 Lead ECG-Inferior Ischemia3010 12 Lead ECG-Lateral Ischemia3015Agonal/Idioventricular3020 Artifact3025Asystole3030 Atrial Fibrillation/Flutter3035AV Block-1st Degree3040 AV Block-2nd Degree-Type 13045AV Block-2nd Degree-Type 23050 AV Block-3rd Degree3055Junctional3060 Left Bundle Branch Block3065Normal Sinus Rhythm3070 Other3075Paced Rhythm3080 PEA3085Premature Atrial Contractions3090 Premature Ventricular Contractions3095Right Bundle Branch Block3100 Sinus Arrhythmia3105Sinus Bradycardia3110 Sinus Tachycardia3115Supraventricular Tachycardia3120 Torsades De Points3125Unknown AED Non-Shockable Rhythm3130 Unknown AED Shockable Rhythm3135Ventricular Fibrillation3140 Ventricular Tachycardia3145



CardiacRythmXSD Domain (Simple Type)XSD Data Type xs:integer

Multiple Entry Configuratio (1) Yes, via structure. (2) Yes for each E14_01 Date/Time

Required in XSD No

Accepts Null Value Yes

XSD Structure: Each element is section E14 is associated with a E14_01 Date/Time

References in NHTSA Version 166 Initial Cardiac RhythmElement Desirable


DefinitionThe patient's systolic blood pressure

Field Values

Data Format [number]E14_04SBP (SYSTOLIC BLOOD PRESSURE)

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

Other Associated ElementsPatient Care Report NumberE01_01 Date/Time Vital Signs TakenE14_01DBP (Diastolic Blood Pressure)E14_05 Method of Blood Pressure MeasurementE14_06




SBPXSD Domain (Simple Type)XSD Data Type xs:integer



0 400XSD 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


References in NHTSA Version 170 Systolic Blood PressureElement Essential


DefinitionThe patient's diastolic blood pressure

Field Values

Data Format [number]E14_05DBP (DIASTOLIC BLOOD PRESSURE)

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

Other Associated ElementsPatient Care Report NumberE01_01 Date/Time Vital Signs TakenE14_01SBP (Systolic Blood Pressure)E14_04 Method of Blood Pressure MeasurementE14_06




DBPXSD Domain (Simple Type)XSD Data Type xs:integer



0 300XSD 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


References in NHTSA Version 171 Diastolic Blood PressureElement Essential


DefinitionIndication of method of blood pressure procedure.

Field Values

Data Format [combo] single-choiceE14_06METHOD OF BLOOD PRESSURE MEASUREMENT

Other Associated ElementsPatient Care Report NumberE01_01 Date/Time Vital Signs TakenE14_01SBP (Systolic Blood Pressure)E14_04 DBP (Diastolic Blood Pressure)E14_05

Arterial Line3150 Automated Cuff3155Manual Cuff3160 Palpated Cuff3165Venous Line3170



MethodOfBloodPressureXSD Domain (Simple Type)XSD Data Type xs:integer



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


DefinitionThe patient's pulse rate, palpated or auscultated, expressed as a number per minute

Field Values

Data Format [number]E14_07PULSE RATE

Additional InformationCould be collected from Device Pulse Rate (E21_13)●

Other Associated ElementsPatient Care Report NumberE01_01 Date/Time Vital Signs TakenE14_01

References to Other DatabasesEMS Module; Title: Patient Pulse; Presence of a Pulse at the time of patient transfer to another service.; Pick-List: Pulse on Transfer = 1, No; Pulse of Transfer = 2

● NFIRS 5.0




PulseRateXSD Domain (Simple Type)XSD Data Type xs:integer





References in NHTSA Version 165 Pulse RateElement Essential


DefinitionThe patient’s heart rate as recorded by an electronic monitoring device (ECG, pulse oximetry, etc.)

Field Values

Data Format [number]E14_08ELECTRONIC MONITOR RATE

Additional InformationCould be collected from Device Heart Rate (E21_12)●





ElectricMonitorRateXSD Domain (Simple Type)XSD Data Type xs:integer






DefinitionThe patient's oxygen saturation

Field Values

Data Format [number]E14_09PULSE OXIMETRY

Additional InformationCould be collected from Device Pulse Oximetry (E21_17)●





PulseOximetryXSD Domain (Simple Type)XSD Data Type xs:integer






DefinitionThe clinical rhythm of the patients pulse (regular, irregular, etc.)

Field Values

Data Format [combo] single-choiceE14_10PULSE RHYTHM


Not Applicable-25 Not Known-10Not Available-5 Regular3175Irregular3180



PulseRhythmXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe patient's respiratory rate expressed as a number per minute

Field Values

Data Format [number]E14_11RESPIRATORY RATE

Additional InformationCould be collected from Device Respiratory Rate (E21_16)●





RespiratoryRateXSD Domain (Simple Type)XSD Data Type xs:integer





References in NHTSA Version 168 Respiratory RateElement Essential


DefinitionThe patient’s respiratory effort

Field Values

Data Format [text]E14_12RESPIRATORY EFFORT


Not Applicable-25 Not Known-10Not Available-5 Normal3185Labored3190 Fatigued3195Absent3200 Not Assessed3205



RespiratoryEffortXSD Domain (Simple Type)XSD Data Type xs:integer




References in NHTSA Version 169 Respiratory EffortElement Desirable


DefinitionThe patient’s end-tidal or other CO2 level.

Field Values

Data Format [number]E14_13CARBON DIOXIDE

Additional InformationCould be collected from Device CO2 or ETCO2 (E21_18)●





CO2XSD Domain (Simple Type)XSD Data Type xs:integer






DefinitionThe patient's blood glucose level

Field Values

Data Format [number]E14_14BLOOD GLUCOSE LEVEL





BloodGlucoseLevelXSD Domain (Simple Type)XSD Data Type xs:integer






DefinitionThe patient's Glasgow Coma Score Eye opening

Field Values

Data Format [number]E14_15GLASGOW COMA SCORE-EYE

Additional InformationCan be configured as a single choice list box●

Other Associated ElementsPatient Care Report NumberE01_01 Date/Time Vital Signs TakenE14_01Glasgow Coma Score-VerbalE14_16 Glasgow Coma Score-MotorE14_17Glasgow Coma Score-QualifierE14_18 Total Glasgow Coma ScoreE14_19

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● ●



GCSEyeXSD Domain (Simple Type)XSD Data Type xs:integer



1 4XSD 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


References in NHTSA Version 173 Glasgow Eye Opening ComponentElement Essential


DefinitionThe patient's Glasgow Coma Score Verbal

Field Values

Data Format [number]E14_16GLASGOW COMA SCORE-VERBAL


Other Associated ElementsPatient Care Report NumberE01_01 Date/Time Vital Signs TakenE14_01Glasgow Coma Score-EyeE14_15 Glasgow Coma Score-MotorE14_17Glasgow Coma Score-QualifierE14_18 Total Glasgow Coma ScoreE14_19

Patients 0-23 months: 1 = None● Patients 2-5 years: 1 = None● Patients 0-23 months: 2 = Persistent cry● Patients 2-5 years: 2 = Grunts● Patients 0-23 months: 3 = Inappropriate cry● Patients 2-5 years: 3 = Cries and/or screams● Patients 0-23 months: 4 = Cries, inconsolable● Patients 2-5 years: 4 = Inappropriate words● Patients 0-23 months: 5 = Smiles, coos, cries appropriately

● Patients 2-5 years: 5 = Appropriate words●

● ● 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●



GCSVerbalXSD Domain (Simple Type)XSD Data Type xs:integer





References in NHTSA Version 174a Glasgow Verbal Component For patients >5 yearsElement Essential74b Glasgow Verbal Component For patients 2-5 yearsElement Essential74c Glasgow Verbal Component for patients 0-23 monthsElement Essential


DefinitionThe patient's Glasgow Coma Score Motor

Field Values

Data Format [number]E14_17GLASGOW COMA SCORE-MOTOR


Other Associated ElementsPatient Care Report NumberE01_01 Date/Time Vital Signs TakenE14_01Glasgow Coma Score-EyeE14_15 Glasgow Coma Score-VerbalE14_16Glasgow Coma Score-QualifierE14_18 Total Glasgow Coma ScoreE14_19

Patients up to 5 years: 1 = None● Patients >5 years: 1 = None● Patients up to 5 years: 2 = Extensor posturing in response to painful stimulation

● Patients >5 years: 2 = Extensor posturing in response to painful stimulation

●

Patients up to 5 years: 3 = Flexor posturing in response to painful stimulation

● Patients >5 years: 3 = Flexor posturing in response to painful stimulation

●

Patients up to 5 years: 4 = General withdrawal in response to painful stimulation

● Patients >5 years: 4 = General withdrawal in response to painful stimulation

●

Patients up to 5 years: 5 = Localization of painful stimulation

● Patients >5 years: 5 = Localization of painful stimulation●

Patients up to 5 years: 6 = Spontaneous● Patients >5 years: 6 = Obeys commands with appropriate motor responses

●



GCSMotorXSD Domain (Simple Type)XSD Data Type xs:integer





References in NHTSA Version 175a Glasgow Motor Component For patients >5 yearsElement Essential75b Glasgow Motor Component For patients up to 5 yearsElement Essential


DefinitionDocumentation of factors which make the GCS score more meaningful.

Field Values

Data Format [combo] single-choiceE14_18GLASGOW COMA SCORE-QUALIFIER


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time Vital Signs TakenE14_01 Glasgow Coma Score-EyeE14_15Glasgow Coma Score-VerbalE14_16 Glasgow Coma Score-MotorE14_17Total Glasgow Coma ScoreE14_19

Not Applicable-25 Not Known-10Not Available-5 Initial GCS has legitimate values without interventions

such as intubation and sedation3210

Patient Chemically Sedated3215 Patient Intubated3220Patient Intubated and Chemically Paralyzed3225



GCSQualifierXSD Domain (Simple Type)XSD Data Type xs:integer



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


DefinitionThe patient's total Glasgow Coma Score

Field Values

Data Format [number]E14_19TOTAL GLASGOW COMA SCORE

Additional InformationCalculated from Glasgow Coma Score-Eye (E14_15), Glasgow Coma Score-Verbal (E14_16), and Glasgow Coma Score-Motor (E14_17)

●

Other Associated ElementsPatient Care Report NumberE01_01 Date/Time Vital Signs TakenE14_01Glasgow Coma Score-EyeE14_15 Glasgow Coma Score-VerbalE14_16Glasgow Coma Score-MotorE14_17 Glasgow Coma Score-QualifierE14_18



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

●

TotalGCSXSD Domain (Simple Type)XSD Data Type xs:integer





References in NHTSA Version 176 Glasgow Coma Score (Total)Element Desirable


DefinitionThe patient's body temperature in degrees celsius/centigrade.

Field Values

Data Format [number]E14_20TEMPERATURE

Other Associated ElementsPatient Care Report NumberE01_01 Date/Time Vital Signs TakenE14_01Temperature MethodE14_21




BodyTemperatureXSD Domain (Simple Type)XSD Data Type xs:decimal



0 50XSD Structure: (1) Each element is section E14 is associated with a E14_01 Date/Time. (2) E14_20 and E14_21 are members of E14_20_0 Temperature Structure.



DefinitionThe method used to obtain the patient’s body temperature

Field Values

Data Format [combo] single-choiceE14_21TEMPERATURE METHOD

Other Associated ElementsPatient Care Report NumberE01_01 Date/Time Vital Signs TakenE14_01TemperatureE14_20

Axillary3230 Oral3235Rectal3240 Tympanic3245Urinary catheter3250



TemperatureMethodXSD Domain (Simple Type)XSD Data Type xs:integer



XSD Structure: (1) Each element is section E14 is associated with a E14_01 Date/Time. (2) E14_20 and E14_21 are members of E14_20_0 Temperature Structure.


DefinitionThe patients level of responsiveness

Field Values

Data Format [combo] single-choiceE14_22LEVEL OF RESPONSIVENESS


Not Applicable-25 Not Known-10Not Available-5 Alert3255Verbal3260 Painful3265Unresponsive3270



LevelOfResponsivenessXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe patient’s indication of pain from a scale of 0 –10.

Field Values

Data Format [number]E14_23PAIN SCALE

Additional InformationNumber from 0 to 10●




Data CollectorEMS agency●

PainScaleXSD Domain (Simple Type)XSD Data Type xs:integer






DefinitionType of injury identified and associated with the external body/Skin (including burns)

Field Values

Data Format [combo] multiple-choiceE15_01NHTSA INJURY MATRIX EXTERNAL/SKIN

Additional InformationBlunt Injury Removed from NHTSA 1.0●


References to Other DatabasesEMS Module; Title: Body Site of Injury; Describes parts of the body where injuries occurred.; Pick-List (limited to 5 max body parts): Head = 1, Neck and Shoulder = 2, Thorax, Includes Chest and Back, Excludes Spine = 3, Abdomen = 4, Spine = 5, Upper Extremities = 6, Lower Extremities = 7, Internal = 8, Multiple Body Parts = 9, No Body Site of Injury = N

● NFIRS 5.0

EMS Module; Title: Injury Type; Describes the primary injuries sustained by a patient for each part of the body.; Pick-List: Amputation = 10, Blunt Injury = 11, Burn = 12, Crush = 13, Dislocation/Fracture = 14, Gunshot = 15, Laceration = 16, Pain Without Swelling = 17, Puncture/Stab = 18, Soft Tissue Swelling = 19, Other Injury Type = 00

● NFIRS 5.0

Not Applicable-25 Not Known-10Not Available-5 Amputation3320Bleeding Controlled3325 Bleeding Uncontrolled3330Burn3335 Crush3340Dislocation Fracture3345 Gunshot3350Laceration3355 Pain without swelling/bruising3360Puncture/stab3365 Soft Tissue Swelling/brushing3370



NHTSAInjuryMatrixXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 153 Injury DescriptionElement Essential

Section E15 Assessment/ Injury Page 341 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionType of injury identified and associated with the Head (excluding face, neck, cervical spine, and ear)

Field Values

Data Format [combo] multiple-choiceE15_02NHTSA INJURY MATRIX HEAD











DefinitionType of injury identified and associated with the Face (including ear)

Field Values

Data Format [combo] multiple-choiceE15_03NHTSA INJURY MATRIX FACE











DefinitionType of injury identified and associated with the Neck

Field Values

Data Format [combo] multiple-choiceE15_04NHTSA INJURY MATRIX NECK




● NFIRS 5.0


● NFIRS 5.0









DefinitionType of injury identified and associated with the Thorax (excluding the thoracic spine)

Field Values

Data Format [combo] multiple-choiceE15_05NHTSA INJURY MATRIX THORAX




● NFIRS 5.0


● NFIRS 5.0









DefinitionType of injury identified and associated with the Abdomen (excluding the lumbar spine)

Field Values

Data Format [combo] multiple-choiceE15_06NHTSA INJURY MATRIX ABDOMEN




● NFIRS 5.0


● NFIRS 5.0









DefinitionType of injury identified and associated with the Spine

Field Values

Data Format [combo] multiple-choiceE15_07NHTSA INJURY MATRIX SPINE




● NFIRS 5.0


● NFIRS 5.0









DefinitionType of injury identified and associated with the Upper Extremities

Field Values

Data Format [combo] multiple-choiceE15_08NHTSA INJURY MATRIX UPPER EXTREMITIES




● NFIRS 5.0


● NFIRS 5.0









DefinitionType of injury identified and associated with the Pelvis

Field Values

Data Format [combo] multiple-choiceE15_09NHTSA INJURY MATRIX PELVIS




● NFIRS 5.0


● NFIRS 5.0









DefinitionType of injury identified and associated with the Lower Extremities

Field Values

Data Format [combo] multiple-choiceE15_10NHTSA INJURY MATRIX LOWER EXTREMITIES




● NFIRS 5.0


● NFIRS 5.0









DefinitionType of injury identified and associated with Unspecified

Field Values

Data Format [combo] multiple-choiceE15_11NHTSA INJURY MATRIX UNSPECIFIED




● NFIRS 5.0


● NFIRS 5.0









DefinitionThe patient’s body weight in kilograms, either measured or estimated

Field Values

Data Format [number]E16_01ESTIMATED BODY WEIGHT



UsesPart of an EMS Medical Record and to better determine equipment sizes and medication dosages● Provides documentation of Assessment and Care● Used in Quality Management for the evaluation of Care and EMS Agency Performance●


EstimatedBodyWeightXSD Domain (Simple Type)XSD Data Type xs:integer




Section E16 Assessment/ Exam Page 353 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe date/time assessment was made on the patient

Field Values

Data Format [date/time]E16_03DATE/TIME OF ASSESSMENT


●

This is a multiple entry configuration which will allow multiple assessments to be documented●

Other Associated ElementsPatient Care Report NumberE01_01 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12GU AssessmentE16_13 Back Cervical AssessmentE16_14Back Thoracic AssessmentE16_15 Back Lumbar/Sacral AssessmentE16_16Extremities-Right Upper AssessmentE16_17 Extremities-Right Lower AssessmentE16_18Extremities-Left Upper AssessmentE16_19 Extremities-Left Lower AssessmentE16_20Eyes-Left AssessmentE16_21 Eyes-Right AssessmentE16_22Mental Status AssessmentE16_23 Neurological AssessmentE16_24







1990 2030XSD Structure: All data elements beginning with E16_03 and ending with E16_24 are all members of E16_00_0 Assessment Structure



DefinitionThe assessment of the patient's skin on examination

Field Values

Data Format [combo] multiple-choiceE16_04SKIN ASSESSMENT

Additional InformationAssociated in Database schema to Date/Time (E16_03) to allow multiple assessments●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Head/Face AssessmentE16_05Neck AssessmentE16_06 Chest/Lungs AssessmentE16_07Heart AssessmentE16_08 Abdomen Left Upper AssessmentE16_09Abdomen Left Lower AssessmentE16_10 Abdomen Right Upper AssessmentE16_11Abdomen Right Lower AssessmentE16_12 GU AssessmentE16_13Back Cervical AssessmentE16_14 Back Thoracic AssessmentE16_15Back Lumbar/Sacral AssessmentE16_16 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24

Not Applicable-25 Not Known-10Not Available-5 Normal3420Not Done3425 Clammy3430Cold3435 Cyanotic3440Jaundiced3445 Lividity3450Mottled3455 Pale3460Warm3465



SkinAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer



XSD Structure: All data elements beginning with E16_03 and ending with E16_24 are all members of E16_00_0 Assessment Structure

References in NHTSA Version 172 Skin PerfusionElement Desirable


DefinitionThe assessment of the patient’s face on examination

Field Values

Data Format [combo] multiple-choiceE16_05HEAD/FACE ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Neck AssessmentE16_06 Chest/Lungs AssessmentE16_07Heart AssessmentE16_08 Abdomen Left Upper AssessmentE16_09Abdomen Left Lower AssessmentE16_10 Abdomen Right Upper AssessmentE16_11Abdomen Right Lower AssessmentE16_12 GU AssessmentE16_13Back Cervical AssessmentE16_14 Back Thoracic AssessmentE16_15Back Lumbar/Sacral AssessmentE16_16 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24

Not Applicable-25 Not Known-10Not Available-5 Normal3470Not Done3475 Asymmetric Smile or Droop3480Drainage3485 Mass/Lesion3490Swelling3495



HeadFaceAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's head & neck area on examination

Field Values

Data Format [combo] multiple-choiceE16_06NECK ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Chest/Lungs AssessmentE16_07Heart AssessmentE16_08 Abdomen Left Upper AssessmentE16_09Abdomen Left Lower AssessmentE16_10 Abdomen Right Upper AssessmentE16_11Abdomen Right Lower AssessmentE16_12 GU AssessmentE16_13Back Cervical AssessmentE16_14 Back Thoracic AssessmentE16_15Back Lumbar/Sacral AssessmentE16_16 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24

Not Applicable-25 Not Known-10Not Available-5 Normal3500Not Done3505 JVD3510Strider3515 SubQ Air3520Tracheal Dev3525



NeckAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's chest on examination

Field Values

Data Format [combo] multiple-choiceE16_07CHEST/LUNGS ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Heart AssessmentE16_08 Abdomen Left Upper AssessmentE16_09Abdomen Left Lower AssessmentE16_10 Abdomen Right Upper AssessmentE16_11Abdomen Right Lower AssessmentE16_12 GU AssessmentE16_13Back Cervical AssessmentE16_14 Back Thoracic AssessmentE16_15Back Lumbar/Sacral AssessmentE16_16 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24

Not Applicable-25 Not Known-10Not Available-5 Normal3530Not Done3535 Accessory Muscles3540Decreased BS-Left3545 Decreased BS-Right3550Flail Segment-Left3555 Flail Segment-Right3560Increased Effort3565 Normal BS3570Rales3575 Rhonchi/Wheezing3580Tenderness-Left3585 Tenderness-Right3590



ChestLungsAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's heart on examination

Field Values

Data Format [combo] multiple-choiceE16_08HEART ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Head/Face AssessmentE16_05Neck AssessmentE16_06 Chest/Lungs AssessmentE16_07Chest/Lungs AssessmentE16_07 Abdomen Left Upper AssessmentE16_09Abdomen Left Lower AssessmentE16_10 Abdomen Right Upper AssessmentE16_11Abdomen Right Lower AssessmentE16_12 GU AssessmentE16_13Back Cervical AssessmentE16_14 Back Thoracic AssessmentE16_15Back Lumbar/Sacral AssessmentE16_16 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24

Not Applicable-25 Not Known-10Not Available-5 Normal3595Not Done3600 Decreased Sounds3605Murmur3610



HeartAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's left upper abdomen on examination

Field Values

Data Format [combo] multiple-choiceE16_09ABDOMEN LEFT UPPER ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Lower AssessmentE16_10 Abdomen Right Upper AssessmentE16_11Abdomen Right Lower AssessmentE16_12 GU AssessmentE16_13Back Cervical AssessmentE16_14 Back Thoracic AssessmentE16_15Back Lumbar/Sacral AssessmentE16_16 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24

Not Applicable-25 Not Known-10Not Available-5 Normal3615Not Done3620 Distention3625Guarding3630 Mass3635Tenderness3640



AbdomenLeftUpperAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's left lower abdomen on examination

Field Values

Data Format [combo] multiple-choiceE16_10ABDOMEN LEFT LOWER ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Right Upper AssessmentE16_11Abdomen Right Lower AssessmentE16_12 GU AssessmentE16_13Back Cervical AssessmentE16_14 Back Thoracic AssessmentE16_15Back Lumbar/Sacral AssessmentE16_16 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24




AbdomenLowerLeftAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's right upper abdomen on examination

Field Values

Data Format [combo] multiple-choiceE16_11ABDOMEN RIGHT UPPER ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Lower AssessmentE16_12 GU AssessmentE16_13Back Cervical AssessmentE16_14 Back Thoracic AssessmentE16_15Back Lumbar/Sacral AssessmentE16_16 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24




AbdomenRightUpperAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's right lower abdomen on examination

Field Values

Data Format [combo] multiple-choiceE16_12ABDOMEN RIGHT LOWER ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 GU AssessmentE16_13Back Cervical AssessmentE16_14 Back Thoracic AssessmentE16_15Back Lumbar/Sacral AssessmentE16_16 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24




AbdomenRightLowerAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's GU area on examination

Field Values

Data Format [combo] multiple-choiceE16_13GU ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12Back Cervical AssessmentE16_14 Back Thoracic AssessmentE16_15Back Lumbar/Sacral AssessmentE16_16 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24

Not Applicable-25 Not Known-10Not Available-5 Normal3735Not Done3740 Crowning3745Genital Injury3750 Tenderness3755Unstable3760



GUAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's back-cervical on examination

Field Values

Data Format [combo] multiple-choiceE16_14BACK CERVICAL ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12GU AssessmentE16_13 Back Thoracic AssessmentE16_15Back Lumbar/Sacral AssessmentE16_16 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24

Not Applicable-25 Not Known-10Not Available-5 Normal3765Not Done3770 Pain to ROM3775Tender Para-spinous3780 Tender Spinous Process3785



BackCervicalAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's back-thoracic on examination

Field Values

Data Format [combo] multiple-choiceE16_15BACK THORACIC ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12GU AssessmentE16_13 Back Cervical AssessmentE16_14Back Lumbar/Sacral AssessmentE16_16 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24




BackThoracicAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's back-lumbar/sacral on examination

Field Values

Data Format [combo] multiple-choiceE16_16BACK LUMBAR/SACRAL ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12GU AssessmentE16_13 Back Cervical AssessmentE16_14Back Thoracic AssessmentE16_15 Extremities-Right Upper AssessmentE16_17Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24




BackLumbarSacralAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's right upper extremities on examination

Field Values

Data Format [combo] multiple-choiceE16_17EXTREMITIES-RIGHT UPPER ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12GU AssessmentE16_13 Back Cervical AssessmentE16_14Back Thoracic AssessmentE16_15 Back Lumbar/Sacral AssessmentE16_16Extremities-Right Lower AssessmentE16_18 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24

Not Applicable-25 Not Known-10Not Available-5 Normal3840Not Done3845 Abnormal Pulse3850Abnormal Sensation3855 Edema3860Tenderness3865 Weakness3870



ExtremitiesRightUpperAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's right lower extremities on examination

Field Values

Data Format [combo] multiple-choiceE16_18EXTREMITIES-RIGHT LOWER ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12GU AssessmentE16_13 Back Cervical AssessmentE16_14Back Thoracic AssessmentE16_15 Back Lumbar/Sacral AssessmentE16_16Extremities-Right Upper AssessmentE16_17 Extremities-Left Upper AssessmentE16_19Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24




ExtremitiesRightLowerAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's left upper extremities on examination

Field Values

Data Format [combo] multiple-choiceE16_19EXTREMITIES-LEFT UPPER ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12GU AssessmentE16_13 Back Cervical AssessmentE16_14Back Thoracic AssessmentE16_15 Back Lumbar/Sacral AssessmentE16_16Extremities-Right Upper AssessmentE16_17 Extremities-Right Lower AssessmentE16_18Extremities-Left Lower AssessmentE16_20 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24




ExtremitiesLeftUpperAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's left lower extremities on examination

Field Values

Data Format [combo] multiple-choiceE16_20EXTREMITIES-LEFT LOWER ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12GU AssessmentE16_13 Back Cervical AssessmentE16_14Back Thoracic AssessmentE16_15 Back Lumbar/Sacral AssessmentE16_16Extremities-Right Upper AssessmentE16_17 Extremities-Right Lower AssessmentE16_18Extremities-Left Upper AssessmentE16_19 Eyes-Left AssessmentE16_21Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24




ExtremitiesLeftLowerAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's left eye on examination

Field Values

Data Format [combo] multiple-choiceE16_21EYES-LEFT ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12GU AssessmentE16_13 Back Cervical AssessmentE16_14Back Thoracic AssessmentE16_15 Back Lumbar/Sacral AssessmentE16_16Extremities-Right Upper AssessmentE16_17 Extremities-Right Lower AssessmentE16_18Extremities-Left Upper AssessmentE16_19 Extremities-Left Lower AssessmentE16_20Eyes-Right AssessmentE16_22 Mental Status AssessmentE16_23Neurological AssessmentE16_24

Not Applicable-25 Not Known-10Not Available-5 Not Done39802-mm3985 3-mm39904-mm3995 5-mm40006-mm4005 7-mm4010Blind4015 Reactive4020Non-Reactive4025



EyesLeftAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's right eye on examination

Field Values

Data Format [combo] multiple-choiceE16_22EYES-RIGHT ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12GU AssessmentE16_13 Back Cervical AssessmentE16_14Back Thoracic AssessmentE16_15 Back Lumbar/Sacral AssessmentE16_16Extremities-Right Upper AssessmentE16_17 Extremities-Right Lower AssessmentE16_18Extremities-Left Upper AssessmentE16_19 Extremities-Left Lower AssessmentE16_20Eyes-Left AssessmentE16_21 Mental Status AssessmentE16_23Neurological AssessmentE16_24

Not Applicable-25 Not Known-10Not Available-5 Not Done40302-mm4035 3-mm40404-mm4045 5-mm40506-mm4055 7-mm4060Blind4065 Reactive4070Non-Reactive4075



EyesRightAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's mental status on examination

Field Values

Data Format [combo] multiple-choiceE16_23MENTAL STATUS ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12GU AssessmentE16_13 Back Cervical AssessmentE16_14Back Thoracic AssessmentE16_15 Back Lumbar/Sacral AssessmentE16_16Extremities-Right Upper AssessmentE16_17 Extremities-Right Lower AssessmentE16_18Extremities-Left Upper AssessmentE16_19 Extremities-Left Lower AssessmentE16_20Eyes-Left AssessmentE16_21 Eyes-Right AssessmentE16_22Neurological AssessmentE16_24

Not Applicable-25 Not Known-10Not Available-5 Normal4080Not Done4085 Combative4090Confused4095 Hallucinations4100Oriented-Person4105 Oriented-Place4110Oriented-Time4115 Unresponsive4120



MentalStatusAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe assessment of the patient's neurological status on examination

Field Values

Data Format [combo] multiple-choiceE16_24NEUROLOGICAL ASSESSMENT


Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time of AssessmentE16_03 Skin AssessmentE16_04Head/Face AssessmentE16_05 Neck AssessmentE16_06Chest/Lungs AssessmentE16_07 Heart AssessmentE16_08Abdomen Left Upper AssessmentE16_09 Abdomen Left Lower AssessmentE16_10Abdomen Right Upper AssessmentE16_11 Abdomen Right Lower AssessmentE16_12GU AssessmentE16_13 Back Cervical AssessmentE16_14Back Thoracic AssessmentE16_15 Back Lumbar/Sacral AssessmentE16_16Extremities-Right Upper AssessmentE16_17 Extremities-Right Lower AssessmentE16_18Extremities-Left Upper AssessmentE16_19 Extremities-Left Lower AssessmentE16_20Eyes-Left AssessmentE16_21 Eyes-Right AssessmentE16_22Mental Status AssessmentE16_23

Not Applicable-25 Not Known-10Not Available-5 Normal4125Not Done4130 Abnormal Gait4135Facial Droop4140 Seizures4145Speech Normal4150 Speech Slurring4155Tremors4160 Weakness-Left Sided4165Weakness=Right Sided4170



NeurologicalAssessmentXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe protocol used by EMS personnel to direct the clinical care of the patient

Field Values

Data Format [combo] multiple-choiceE17_01PROTOCOLS USED

Additional InformationList created from Protocols (D04_08)●



UsesPart of an EMS Medical Record● Provides documentation of Assessment and Care● 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●


ProtocolsUsedXSD Domain (Simple Type)XSD Data Type xs:string




Section E17 Intervention Page 378 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe date/time medication administered to the patient

Field Values

Data Format [date/time]E18_01DATE/TIME MEDICATION ADMINISTERED


●

This is a multiple entry configuration which will allow multiple medication administrations to be documented●

Other Associated ElementsPatient Care Report NumberE01_01 Medication Administered Prior to this Units

EMS CareE18_02

Medication GivenE18_03 Medication Administered RouteE18_04Medication DosageE18_05 Medication Dosage UnitsE18_06Response to MedicationE18_07 Medication ComplicationE18_08Medication Crew Member IDE18_09 Medication AuthorizationE18_10Medication Authorizing PhysicianE18_11


UsesPart 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●





1990 2030XSD Structure: All data elements section E18 are members of the E18 Medication Structure


Section E18 Intervention/ Medication Page 380 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionIndicates that the medication administration which is documented was administered prior to this EMS unit’s care.

Field Values

Data Format [combo] single-choiceE18_02MEDICATION ADMINISTERED PRIOR TO THIS UNITS EMS CARE

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

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time Medication AdministeredE18_01 Medication GivenE18_03Medication Administered RouteE18_04 Medication DosageE18_05Medication Dosage UnitsE18_06 Response to MedicationE18_07Medication ComplicationE18_08 Medication Crew Member IDE18_09Medication AuthorizationE18_10 Medication Authorizing PhysicianE18_11







XSD Structure: All data elements section E18 are members of the E18 Medication Structure


DefinitionThe medication given to the patient

Field Values

National ElementData Format [combo] single-choiceE18_03MEDICATION GIVEN

Additional InformationList created from Medications (D04_06)●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time Medication AdministeredE18_01 Medication Administered Prior to this Units

EMS CareE18_02

Medication Administered RouteE18_04 Medication DosageE18_05Medication Dosage UnitsE18_06 Response to MedicationE18_07Medication ComplicationE18_08 Medication Crew Member IDE18_09Medication AuthorizationE18_10 Medication Authorizing PhysicianE18_11

References to Other DatabasesEMS 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

● NFIRS 5.0


UsesAllows 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●


MedicationsGivenXSD Domain (Simple Type)XSD Data Type xs:string





References in NHTSA Version 180 Medication NameElement Essential


DefinitionThe route that the medication was administered to the patient.

Field Values

Data Format [combo] single-choiceE18_04MEDICATION ADMINISTERED ROUTE


EMS CareE18_02

Medication GivenE18_03 Medication DosageE18_05Medication Dosage UnitsE18_06 Response to MedicationE18_07Medication ComplicationE18_08 Medication Crew Member IDE18_09Medication AuthorizationE18_10 Medication Authorizing PhysicianE18_11

References to Other DatabasesDEEDS/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

● DEEDS

Not Applicable-25 Not Known-10Not Available-5 Endotracheal tube4175Gastrostomy tube4180 Inhalation4185Intramuscular4190 Intraosseous4191Intraocular4200 Intravenous4205Nasal4210 Nasal prongs4215Nasogastric4220 Ophthalmic4225Oral4230 Other/miscellaneous4235Otic4240 Re-breather mask4245Rectal4250 Subcutaneous4255Sublingual4260 Topical4265Tracheostomy4270 Transdermal4275Urethral4280 Ventimask4285Wound4290



MedicationAdministeredRouteXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe dose or amount of medication given to the patient

Field Values

Data Format [number]E18_05MEDICATION DOSAGE

Other Associated ElementsPatient Care Report NumberE01_01 Date/Time Medication AdministeredE18_01Medication Administered Prior to this Units EMS Care

E18_02 Medication GivenE18_03

Medication Administered RouteE18_04 Medication Dosage UnitsE18_06Response to MedicationE18_07 Medication ComplicationE18_08Medication Crew Member IDE18_09 Medication AuthorizationE18_10Medication Authorizing PhysicianE18_11




MedicationDosageXSD Domain (Simple Type)XSD Data Type xs:decimal



0 999999.99XSD 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



DefinitionThe units of medication dosage given to patient

Field Values

Data Format [combo] single-choiceE18_06MEDICATION DOSAGE UNITS

Other Associated ElementsPatient Care Report NumberE01_01 Date/Time Medication AdministeredE18_01Medication Administered Prior to this Units EMS Care

E18_02 Medication GivenE18_03

Medication GivenE18_03 Medication Administered RouteE18_04Medication DosageE18_05 Response to MedicationE18_07Medication ComplicationE18_08 Medication Crew Member IDE18_09Medication AuthorizationE18_10 Medication Authorizing PhysicianE18_11

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

GMS4295 Inches4300IU4305 KVO (TKO)4310L/MIN4315 LITERS4320LPM4325 MCG4330MCG/KG/MIN4335 MEQ4340MG4345 MG/KG/MIN4350ML4355 ML/HR4360Other4365 Puffs4370



MedicationDosageUnitsXSD Domain (Simple Type)XSD Data Type xs:integer



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


DefinitionThe patient’s response to the medication.

Field Values

Data Format [combo] single-choiceE18_07RESPONSE TO MEDICATION


EMS CareE18_02

Medication GivenE18_03 Medication Administered RouteE18_04Medication DosageE18_05 Medication Dosage UnitsE18_06Medication ComplicationE18_08 Medication Crew Member IDE18_09Medication AuthorizationE18_10 Medication Authorizing PhysicianE18_11

Not Applicable-25 Not Known-10Not Available-5 Improved4375Unchanged4380 Worse4385



ResponseToMedicationXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionAny complication (abnormal effect on the patient) associated with the administration of the medication to the patient by EMS

Field Values

National ElementData Format [combo] multiple-choiceE18_08MEDICATION COMPLICATION


EMS CareE18_02

Medication GivenE18_03 Medication Administered RouteE18_04Medication DosageE18_05 Medication Dosage UnitsE18_06Response to MedicationE18_07 Medication Crew Member IDE18_09Medication AuthorizationE18_10 Medication Authorizing PhysicianE18_11

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5None4390 Altered Mental Status4395Apnea4400 Bleeding4405Bradycardia4410 Diarrhea4415Extravasion4420 Hypertension4425Hyperthermia4430 Hypotension4435Hypoxia4440 Injury4445Itching/Urticaria4450 Nausea4455Other4460 Respiratory Distress4465Tachycardia4470 Vomiting4475

UsesAllows data to be sorted based on medication complication● Allows data to describe medication complications which occur as a result of EMS treatment● 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●


MedicationComplicationXSD Domain (Simple Type)XSD Data Type xs:integer


Required in XSD Yes




DefinitionThe statewide assigned ID number of the EMS crew member giving the treatment to the patient

Field Values

Data Format [text]E18_09MEDICATION CREW MEMBER ID

Additional InformationLinked 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

●


EMS CareE18_02

Medication GivenE18_03 Medication Administered RouteE18_04Medication DosageE18_05 Medication Dosage UnitsE18_06Response to MedicationE18_07 Medication ComplicationE18_08Medication AuthorizationE18_10 Medication Authorizing PhysicianE18_11


UsesPart 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●


CrewMemberIDXSD Domain (Simple Type)XSD Data Type xs:integer







DefinitionThe type of treatment authorization obtained

Field Values

Data Format [combo] single-choiceE18_10MEDICATION AUTHORIZATION

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


EMS CareE18_02

Medication GivenE18_03 Medication Administered RouteE18_04Medication DosageE18_05 Medication Dosage UnitsE18_06Response to MedicationE18_07 Medication ComplicationE18_08Medication Crew Member IDE18_09 Medication Authorizing PhysicianE18_11Medication Authorizing PhysicianE18_11

Not Applicable-25 Not Known-10Not Available-5 On-Line4480On-Scene4485 Protocol (Standing Order)4490Written Orders (Patient Specific)4495



MedicationAuthorizationXSD Domain (Simple Type)XSD Data Type xs:integer




References in NHTSA Version 181 Treatment AuthorizationElement Desirable


DefinitionThe last name of the authorizing physician ordering the medication administration if the order was provided by any manner other than protocol (standing order) in E18.10

Field Values

Data Format [text]E18_11MEDICATION AUTHORIZING PHYSICIAN

Additional InformationAssociated with Medication Authorization (E18_10) if the value is not “Protocol”●


EMS CareE18_02

Medication GivenE18_03 Medication Administered RouteE18_04Medication DosageE18_05 Medication Dosage UnitsE18_06Response to MedicationE18_07 Medication ComplicationE18_08Medication Crew Member IDE18_09 Medication AuthorizationE18_10










DefinitionThe date and time the procedure was performed on the patient

Field Values

Data Format [date/time]E19_01DATE/TIME PROCEDURE PERFORMED SUCCESSFULLY


●

This is a multiple entry configuration which will allow for multiple procedures to be documented●

Other Associated ElementsPatient Care Report NumberE01_01 Procedure Performed Prior to this Units

EMS CareE19_02

ProcedureE19_03 Size of Procedure EquipmentE19_04Number of Procedure AttemptsE19_05 Procedure SuccessfulE19_06Procedure ComplicationE19_07 Response to ProcedureE19_08Procedure Crew Members IDE19_09 Procedure AuthorizationE19_10Procedure Authorizing PhysicianE19_11 Successful IV SiteE19_12Tube ConfirmationE19_13 Destination Confirmation of Tube

PlacementE19_14







1990 2030XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure


References in NHTSA Version 158 Time of First CPRElement Desirable63 Time of First Defibrillatory ShockElement Desirable

Section E19 Intervention/ Procedure Page 392 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionIndicates that the procedure which was performed and documented was performed prior to this EMS unit’s care.

Field Values

Data Format [combo] single-choiceE19_02PROCEDURE PERFORMED PRIOR TO THIS UNITS EMS CARE

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

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Date/Time Procedure Performed Successfully

E19_01 ProcedureE19_03

Size of Procedure EquipmentE19_04 Number of Procedure AttemptsE19_05Procedure SuccessfulE19_06 Procedure ComplicationE19_07Response to ProcedureE19_08 Procedure Crew Members IDE19_09Procedure AuthorizationE19_10 Procedure Authorizing PhysicianE19_11







XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure


DefinitionThe procedure performed on the patient.

Field Values

National ElementData Format [combo] single-choiceE19_03PROCEDURE

Additional InformationList created from Procedures (D04_04)●


E19_01 Procedure Performed Prior to this Units EMS Care

E19_02

Size of Procedure EquipmentE19_04 Number of Procedure AttemptsE19_05Procedure SuccessfulE19_06 Procedure ComplicationE19_07Response to ProcedureE19_08 Procedure Crew Members IDE19_09Procedure AuthorizationE19_10 Procedure Authorizing PhysicianE19_11

References to Other DatabasesEMS 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

● NFIRS 5.0

Arrest after arrival of EMS could be documented by CPR or Defibrillation performed along with the Cardiac Arrest datapoint.; [text] Value or

● UTSTEIN


UsesAllows 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●


ProcedureXSD Domain (Simple Type)XSD Data Type xs:decimal



0 999.999XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure


References in NHTSA Version 158 Time of First CPRElement Desirable63 Time of First Defibrillatory ShockElement Desirable


DefinitionThe size of equipment used in the procedure on the patient

Field Values

Data Format [text]E19_04SIZE OF PROCEDURE EQUIPMENT

Additional InformationCan 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

●



E19_02

ProcedureE19_03 Number of Procedure AttemptsE19_05Procedure SuccessfulE19_06 Procedure ComplicationE19_07Response to ProcedureE19_08 Procedure Crew Members IDE19_09Procedure AuthorizationE19_10 Procedure Authorizing PhysicianE19_11




SizeOfProcedureEquipmentXSD Domain (Simple Type)XSD Data Type xs:string





References in NHTSA Version 178 Procedure or Treatment NameElement Essential


DefinitionThe number of attempts taken to complete a procedure or intervention regardless of success

Field Values

National ElementData Format [number]E19_05NUMBER OF PROCEDURE ATTEMPTS



E19_02

ProcedureE19_03 Size of Procedure EquipmentE19_04Procedure SuccessfulE19_06 Procedure ComplicationE19_07Response to ProcedureE19_08 Procedure Crew Members IDE19_09Procedure AuthorizationE19_10 Procedure Authorizing PhysicianE19_11


UsesAllows 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●


NumberOfProcedureAttemptsXSD Domain (Simple Type)XSD Data Type xs:integer



-25 100XSD Structure: Data Elements E19_01 through E19_11 are all members of E19_01_0 Procedure Structure



DefinitionIndication of whether or not the procedure performed on the patient was successful

Field Values

National ElementData Format [combo] single-choiceE19_06PROCEDURE SUCCESSFUL



E19_02

ProcedureE19_03 Size of Procedure EquipmentE19_04Number of Procedure AttemptsE19_05 Procedure ComplicationE19_07Response to ProcedureE19_08 Procedure Crew Members IDE19_09Procedure AuthorizationE19_10 Procedure Authorizing PhysicianE19_11


UsesAllows 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●







DefinitionAny complication associated with the performance of the procedure on the patient

Field Values

National ElementData Format [combo] multiple-choiceE19_07PROCEDURE COMPLICATION



E19_02

ProcedureE19_03 Size of Procedure EquipmentE19_04Number of Procedure AttemptsE19_05 Procedure SuccessfulE19_06Response to ProcedureE19_08 Procedure Crew Members IDE19_09Procedure AuthorizationE19_10 Procedure Authorizing PhysicianE19_11

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5None4500 Altered Mental Status4505Apnea4510 Bleeding4515Bradycardia4520 Diarrhea4525Esophageal Intubation-immediately4530 Esophageal Intubation-other4535Extravasion4540 Hypertension4545Hyperthermia4550 Hypotension4555Hypoxia4560 Injury4565Itching/Urticaria4570 Nausea4575Other4580 Respiratory Distress4585Tachycardia4590 Vomiting4595

UsesAllows 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●


ProcedureComplicationXSD Domain (Simple Type)XSD Data Type xs:integer


Required in XSD Yes




DefinitionThe patient’s response to the procedure

Field Values

Data Format [combo] single-choiceE19_08RESPONSE TO PROCEDURE



E19_02

ProcedureE19_03 Size of Procedure EquipmentE19_04Number of Procedure AttemptsE19_05 Procedure SuccessfulE19_06Procedure ComplicationE19_07 Procedure Crew Members IDE19_09Procedure AuthorizationE19_10 Procedure Authorizing PhysicianE19_11




ResponseToProcedureXSD Domain (Simple Type)XSD Data Type xs:integer





DefinitionThe statewide assigned ID number of the EMS crew member performing the procedure on the patient

Field Values

Data Format [text]E19_09PROCEDURE CREW MEMBERS ID

Additional InformationLinked 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

●



E19_02

ProcedureE19_03 Size of Procedure EquipmentE19_04Number of Procedure AttemptsE19_05 Procedure SuccessfulE19_06Procedure ComplicationE19_07 Response to ProcedureE19_08Procedure AuthorizationE19_10 Procedure Authorizing PhysicianE19_11


UsesPart 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●


CrewMemberIDXSD Domain (Simple Type)XSD Data Type xs:integer







DefinitionThe type of procedure authorization obtained

Field Values

Data Format [combo] single-choiceE19_10PROCEDURE AUTHORIZATION

Additional InformationAssociated with Procedure Authorization (E19_11) if the value is not “Protocol”●



E19_02

ProcedureE19_03 Size of Procedure EquipmentE19_04Number of Procedure AttemptsE19_05 Procedure SuccessfulE19_06Procedure ComplicationE19_07 Response to ProcedureE19_08Procedure Crew Members IDE19_09 Procedure Authorizing PhysicianE19_11

Not Applicable-25 Not Known-10Not Available-5 On-Line4615On-Scene4620 Protocol (Standing Order)4625Written Orders (Patient Specific)4630



ProcedureAuthorizationXSD Domain (Simple Type)XSD Data Type xs:integer




References in NHTSA Version 181 Treatment AuthorizationElement Desirable


DefinitionThe last name of the authorizing physician ordering the procedure, if the order was provided by any manner other than protocol (standing order)

Field Values

Data Format [text]E19_11PROCEDURE AUTHORIZING PHYSICIAN

Additional InformationAssociated with Procedure Authorization (E19_10) if the value is not “Protocol”●



E19_02

ProcedureE19_03 Size of Procedure EquipmentE19_04Number of Procedure AttemptsE19_05 Procedure SuccessfulE19_06Procedure ComplicationE19_07 Response to ProcedureE19_08Procedure Crew Members IDE19_09 Procedure AuthorizationE19_10




ProcedureAuthorzingPhysicianXSD Domain (Simple Type)XSD Data Type xs:string






DefinitionThe location of the IV site (if applicable) on the patient

Field Values

Data Format [combo] multiple-choiceE19_12SUCCESSFUL IV SITE

Additional InformationSuccessful 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.

●


Not Applicable-25 Not Known-10Not Available-5 Antecubital-Left4635Antecubital-Right4640 External Jugular-Left4645External Jugular-Right4650 Femoral-Left IV4655Femoral-Left Distal IO4660 Femoral-Right IV4665Femoral-Right IO4670 Forearm-Left4675Forearm-Right4680 Hand-Left4685Hand-Right4690 Lower Extremity-Left4695Lower Extremity-Right4700 Other4705Scalp4710 Sternal IO4715Tibia IO-Left4720 Tibia IO-Right4725Umbilical4730



SuccessfulIVSiteXSD Domain (Simple Type)XSD Data Type xs:integer



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.


DefinitionEndotracheal Tube placement verification at the time the airway procedure was done

Field Values

Data Format [combo] multiple-choiceE19_13TUBE CONFIRMATION

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

●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01ProcedureE19_03

Not Applicable-25 Not Known-10Not Available-5 Auscultation of Bilateral Breath Sounds4735Colormetric CO2 Detector Confirmation4740 Digital CO2 Confirmation4745Esophageal Bulb Aspiration confirmation4750 Negative Auscultation of the Epigastrium4755Visualization of the Chest Rising with ventilation4760 Visualization of Tube Passing Through the Cords4765Waveform CO2 Confirmation4770



TubeConfirmationXSD Domain (Simple Type)XSD Data Type xs:integer



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.


DefinitionEndotracheal Tube location verification on the arrival at the Destination (if applicable)

Field Values

Data Format [combo] multiple-choiceE19_14DESTINATION CONFIRMATION OF TUBE PLACEMENT

Additional InformationThe Destination Confirmation of Tube Placement is not documented with any specific Procedure (E19_03) but should be completed if an Airway Procedure leads to Intubation

●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01ProcedureE19_03

Not Applicable-25 Not Known-10Not Available-5 Auscultation of Bilateral Breath Sounds4775Colormetric CO2 Detector Confirmation4780 Digital CO2 Confirmation4785Esophageal Bulb Aspiration confirmation4790 Negative Auscultation of the Epigastrium4795Visualization of the Chest Rising with ventilation4800 Visualization of Tube Passing Through the Cords4805Waveform CO2 Confirmation4810



DestinationConfirmationOfTubePlacementXSD Domain (Simple Type)XSD Data Type xs:integer



XSD Structure: Destination Confirmation of Tube Placement 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.


DefinitionThe destination the patient was delivered or transferred to

Field Values

Data Format [text]E20_01DESTINATION/TRANSFERRED TO, NAME

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

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Destination/Transferred To, CodeE20_02


UsesA 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●


DestinationTransferredToIDXSD Domain (Simple Type)XSD Data Type xs:string




Section E20 Disposition Page 407 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionThe destination zip code in which the patient was delivered or transferred to

Field Values

National ElementData Format [text]E20_07DESTINATION ZIP CODE

Additional InformationCan be 5 or 9 digit Zip Code●

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Destination/Transferred To, NameE20_01 Destination Street AddressE20_03Destination CityE20_04 Destination StateE20_05


UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on the destination location● Allows data to describe patient's geographic destination● 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●





2 10XSD Structure: E20_03, E20_04, E20_05, and E20_07 are all members of E2-_03_0 Destination Address Structure



DefinitionType of disposition treatment and/or transport of the patient.

Field Values

National ElementData Format [combo] single-choiceE20_10INCIDENT/PATIENT DISPOSITION


References to Other DatabasesEMS 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

● NFIRS 5.0

Cancelled4815 Dead at Scene4820No Patient Found4825 No Treatment Required4830Patient Refused Care4835 Treated and Released4840Treated, Transferred Care4845 Treated, Transported by EMS4850Treated, Transported by Law Enforcement4855 Treated, Transported by Private Vehicle4860

UsesA 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●


IncidentPatientDispositionXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 147 Incident/Patient DispositionElement Essential


DefinitionIndication whether or not lights and/or sirens were used on the vehicle while leaving scene

Field Values

National ElementData Format [combo] single-choiceE20_14TRANSPORT MODE FROM SCENE


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Initial Lights and Sirens, Downgraded to No Lights or Sirens

4955 Initial No Lights or Sirens, Upgraded to Lights and Sirens4960

Lights and Sirens4965 No Lights or Sirens4970

UsesA component of the EMS Medical Record: Patient Care Report● Allows data to be sorted based on the transportation mode● Allows data to describe transportation mode used by EMS●


TransportModeFromSceneXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 146 Lights and Sirens used from the SceneElement Essential


DefinitionThe condition of the patient after care by EMS

Field Values

Data Format [combo] single-choiceE20_15CONDITION OF PATIENT AT DESTINATION


References to Other DatabasesEMS Module; Title: Patient Status; The patient’s status when transferred to another agency.; Pick-List: Improved = 1, Remained Same = 2, Worsened = 3

● NFIRS 5.0


UsesOutcome indicator● Part of an EMS Medical Record● Used in Quality Management for the evaluation of Care and EMS Agency Performance●


ConditionOfPatientAtDestinationXSD Domain (Simple Type)XSD Data Type xs:integer




DefinitionThe reason the unit chose to deliver or transfer the patient to the destination

Field Values

National ElementData Format [combo] single-choiceE20_16REASON FOR CHOOSING DESTINATION


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Closest Facility (none below)4990 Diversion4995Family Choice5000 Insurance Status5005Law Enforcement Choice5010 On-Line Medical Direction5015Other5020 Patient Choice5025Patient's Physicians Choice5030 Protocol5035Specialty Resource Center5040

UsesA 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

●


ReasonForChoosingDestinationXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 145 Destination DeterminationElement Essential


DefinitionThe type of destination the patient was delivered or transferred to

Field Values

National ElementData Format [combo] single-choiceE20_17TYPE OF DESTINATION

Other Associated ElementsCommon Null ValuesE00 Patient Care Report NumberE01_01Destination/Transferred To, NameE20_01

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Home7270 Hospital7280Medical Office/Clinic7290 Morgue7300Nursing Home7320 Other7330Other EMS Responder (air)7340 Other EMS Responder (ground)7350Police/Jail7360

UsesA 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●


TypeOfDestinationXSD Domain (Simple Type)XSD Data Type xs:integer



References in NHTSA Version 144 Destination/Transferred ToElement Essential


DefinitionThe known disposition of the patient from the Emergency Department (ED)

Field Values

National ElementData Format [combo] single-choiceE22_01EMERGENCY DEPARTMENT DISPOSITION


Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Admitted to Hospital Floor5335 Admitted to Hospital ICU5340Death5345 Not Applicable (Not Transported to ED)5350Released5355 Transferred5360

UsesAllows data to be sorted based on the EMS patient outcome● Allows data to describe EMS patient outcome●

Data CollectorEMS Agency: Could be collected by EMS Administration or electronically provided through linkage with hospital databases

●

EmergencyDepartmentDispositionXSD Domain (Simple Type)XSD Data Type xs:integer



Section E22 Outcome and Linkage Page 446 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

DefinitionIndication of how the patient was dispositioned from the hospital, if admitted.

Field Values

National ElementData Format [combo] single-choiceE22_02HOSPITAL DISPOSITION


References to Other DatabasesTitle: Survived Event to ED/ICU; Admitted to ED, Admitted to ICU● UTSTEIN

Not Applicable-25 Not Reporting-15Not Known-10 Not Available-5Death5365 Discharged5370Transfer to Hospital5375 Transfer to Nursing Home5380Transfer to Other5385 Transfer to Rehabilitation Facility5390

UsesAllows data to be sorted based on the EMS patient outcome● Allows data to describe EMS patient outcome●

Data CollectorEMS Agency: Could be collected by EMS Administration or electronically provided through linkage with hospital databases

●

HospitalDispositionXSD Domain (Simple Type)XSD Data Type xs:integer



Section E22 Outcome and Linkage Page 447 of 4632005 NHTSA Uniform PreHospital Dataset V.2.20

national emergency medical services information system...national emergency medical services...

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