NEMSIS 3.5 Changes in Oregon's EMS Information System Fall 2022

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Updated NEMSIS version 3.5 brings significant changes to Oregon's EMS Information System, aiming to help agencies transition from 3.4 to 3.5 by 2022-2023. Oregon is implementing newly collected elements and replacing certain data entry elements to enhance statewide data collection efforts in EMS and trauma systems.

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NEMSIS 3.5 Changes Oregon EMS Information System (OREMSIS) Fall 2022 PUBLIC HEALTH DIVISION EMS and Trauma Systems

Timeline Oregon s goal is to help all agencies switch from NEMSIS 3.4 to 3.5 in 2022 2023. Each agency can pick its own date. PUBLIC HEALTH DIVISION EMS and Trauma Systems 2

NEW/REPLACED ELEMENTS PUBLIC HEALTH DIVISION EMS and Trauma Systems 3

Newly Collected Elements for Oregon eResponse.20 On-Scene Odometer Reading of Responding Vehicle eResponse.21 Patient Destination Odometer Reading of Responding Vehicle eScene.10 Incident Facility Code eSituation.18 Date/Time Last Known Well eHistory.05 Advance Directives eVitals.17 Carbon Monoxide (CO) eVitals.28 Pain Scale Type eAirway.09 Suspected Reasons for Failed Airway Management These elements existed in NEMSIS 3.4, but Oregon is collecting them statewide in NEMSIS 3.5. They should be in your data entry form. PUBLIC HEALTH DIVISION EMS and Trauma Systems 4

New Elements Collected by Oregon ePatient.22 Alternate Home Residence eSituation.20 Reason for Interfacility Transfer/Medical Transport eDisposition.32 Level of Care Provided per Protocol These elements are new in NEMSIS 3.5 and Oregon is collecting them statewide. They should be in your data entry form. PUBLIC HEALTH DIVISION EMS and Trauma Systems 5

Replaced Elements 3.4 3.5 eArrest.05 CPR Care Provided Prior to EMS Arrival eArrest.20 Who First Initiated CPR eArrest.06 Who Provided CPR Prior to EMS Arrival eArrest.21 Who First Applied the AED eArrest.08 Who Used AED Prior to EMS Arrival eArrest.22 Who First Defibrillated the Patient eExam.22 Lung Assessment Finding Location eExam.23 Lung Assessment eExam.08 Chest/Lungs Assessment eExam.24 Chest Assessment Finding Location eExam.25 Chest Assessment These NEMSIS 3.4 elements were replaced by new elements in NEMSIS 3.5. The NEMSIS 3.4 elements should be removed and the NEMSIS 3.5 elements added in your data entry form. PUBLIC HEALTH DIVISION EMS and Trauma Systems 6

Replaced Elements 3.4 3.5 eDisposition.27 Unit Disposition eDisposition.28 Patient Evaluation/Care eDisposition.12 Incident/Patient Disposition eDisposition.29 Crew Disposition eDisposition.30 Transport Disposition This is the biggest change in NEMSIS 3.5 for EMS providers. These NEMSIS 3.4 elements were replaced by new elements in NEMSIS 3.5. The NEMSIS 3.4 elements should be removed and the NEMSIS 3.5 elements added in your data entry form. PUBLIC HEALTH DIVISION EMS and Trauma Systems 7

NEW/REPLACED VALUES PUBLIC HEALTH DIVISION EMS and Trauma Systems 8

eResponse.05 Type of Service Requested 3.4 3.5 911 Response (Scene) Intercept Mutual Aid Emergency Response (Primary Response Area) Emergency Response (Intercept) Emergency Response (Mutual Aid) Hospital-to-Hospital Transfer Hospital to Non-Hospital Facility Transfer Non-Hospital Facility to Non-Hospital Facility Transfer Non-Hospital Facility to Hospital Transfer Other Routine Medical Transport Public Assistance Standby Support Services Non-Patient Care Rescue/Extrication Crew Transport Only Transport of Organs or Body Parts Mortuary Services Mobile Integrated Health Care Encounter Evaluation for Special Referral/Intake Programs Administrative Operations Interfacility Transport Medical Transport Public Assistance/Other Not Listed Standby PUBLIC HEALTH DIVISION EMS and Trauma Systems 9

eResponse.07 Unit Transport and Equipment Capability (Primary Role of the Unit) 3.4 3.5 Air Transport-Fixed Wing Air Transport-Helicopter Air Transport-Fixed Wing Air Transport-Helicopter Ground Transport (ALS Equipped) Ground Transport (BLS Equipped) Ground Transport (Critical Care Equipped) Ground Transport Non-Transport Administrative (e.g., Supervisor) Non-Transport Assistance Non-Transport-No Medical Equipment Non-Transport-Medical Treatment (ALS Equipped) Non-Transport-Medical Treatment (BLS Equipped) Wheel Chair Van/Ambulette Non-Transport Rescue PUBLIC HEALTH DIVISION EMS and Trauma Systems 10

eResponse.08 Type of Dispatch Delay 3.5 Communication Specialist-Assignment Error No Receiving MD, Bed, Hospital Specialty Team Delay PUBLIC HEALTH DIVISION EMS and Trauma Systems 11

eDispatch.01 Dispatch Reason (Complaint Reported by Dispatch) 3.5 Altered Mental Status Intercept Nausea Vomiting PUBLIC HEALTH DIVISION EMS and Trauma Systems 12

ePatient.13 Gender 3.5 Female-to-Male, Transgender Male Male-to-Female, Transgender Female Other, neither exclusively male or female PUBLIC HEALTH DIVISION EMS and Trauma Systems 13

eSituation.01 Date/Time of Symptom Onset Pertinent Negatives 3.5 Approximate Unable to Complete PUBLIC HEALTH DIVISION EMS and Trauma Systems 14

eSituation.10 Other Associated Symptoms Pertinent Negatives 3.5 Symptom Not Present PUBLIC HEALTH DIVISION EMS and Trauma Systems 15

eSituation.13 Initial Patient Acuity 3.5 Non-Acute/Routine PUBLIC HEALTH DIVISION EMS and Trauma Systems 16

eInjury.07 Use of Occupant Safety Equipment 3.5 Unable to Determine PUBLIC HEALTH DIVISION EMS and Trauma Systems 17

eArrest.09 Type of CPR Provided 3.5 Compressions-Hands Only CPR Ventilation-with OPA/NPA Ventilation-Advanced Airway Device Ventilation-Passive Ventilation with Oxygen PUBLIC HEALTH DIVISION EMS and Trauma Systems 18

eArrest.17 Cardiac Rhythm on Arrival at Destination eVitals.03 Cardiac Rhythm / Electrocardiography (ECG) 3.5 Non-STEMI Septal Ischemia STEMI Septal Ischemia PUBLIC HEALTH DIVISION EMS and Trauma Systems 19

eHistory.01 Barriers to Patient Care 3.5 Alcohol Use, Suspected Drug Use, Suspected PUBLIC HEALTH DIVISION EMS and Trauma Systems 20

eVitals.04 ECG Type 3.5 2 Lead ECG (pads or paddles) PUBLIC HEALTH DIVISION EMS and Trauma Systems 21

eVitals.30 Stroke Scale Type 3.5 Boston Stroke Scale (BOSS) Los Angeles Motor Score (LAMS) Los Angeles Prehospital Stroke Screen (LAPSS) Melbourne Ambulance Stroke Screen (MASS) Ontario Prehospital Stroke Scale (OPSS) Rapid Arterial oCclusion Evaluation (RACE) PUBLIC HEALTH DIVISION EMS and Trauma Systems 22

eExam.15 Extremity Assessment Finding Location 3.5 Arm-Whole Arm and Hand-Left Arm-Whole Arm and Hand-Right Hand-Whole Hand-Left Hand-Whole Hand-Right Leg-Whole Leg-Left Leg-Whole Leg-Right Foot-Whole Foot-Left Foot-Whole Foot-Right PUBLIC HEALTH DIVISION EMS and Trauma Systems 23

eExam.18 Eye Assessment 3.5 Dilated Pin Point PUBLIC HEALTH DIVISION EMS and Trauma Systems 24

eExam.19 Mental Status Assessment 3.5 Altered mental status, unspecified Developmentally Impaired Disorientation, unspecified Pharmacologically Paralyzed Pharmacologically Sedated Psychologically Impaired Slowness and poor responsiveness State of emotional shock and stress, unspecified Strange and inexplicable behavior Uncooperative Unspecified coma PUBLIC HEALTH DIVISION EMS and Trauma Systems 25

eExam.20 Neurological Assessment 3.5 Status Seizure Other Seizures PUBLIC HEALTH DIVISION EMS and Trauma Systems 26

eMedications.03 Medication Administered Pertinent Negative 3.5 Order Criteria Not Met PUBLIC HEALTH DIVISION EMS and Trauma Systems 27

eMedications.04 Medication Administered Route 3.5 Auto Injector BVM CPAP IV Pump Nebulizer Umbilical Artery Catheter Umbilical Venous Catheter PUBLIC HEALTH DIVISION EMS and Trauma Systems 28

eMedications.06 Medication Administered Units 3.5 Milligrams per Hour (mg/hr) PUBLIC HEALTH DIVISION EMS and Trauma Systems 29

eMedications.10 Role/Type of Person Administering Medication eProcedures.10 Role/Type of Person Performing the Procedure 3.4 3.5 Fire Personnel (non EMS) Law Enforcement Family Member Lay Person Patient First Responder Patient/Lay Person PUBLIC HEALTH DIVISION EMS and Trauma Systems 30

eProcedures.13 Vascular Access Location 3.5 Wrist-Left Wrist-Right PUBLIC HEALTH DIVISION EMS and Trauma Systems 31

eAirway.04 Airway Device Placement Confirmed Method 3.5 Chest Rise PUBLIC HEALTH DIVISION EMS and Trauma Systems 32

eDisposition.19 Final Patient Acuity 3.5 Dead with Resuscitation Efforts (Black) Non-Acute/Routine PUBLIC HEALTH DIVISION EMS and Trauma Systems 33

eDisposition.21 Type of Destination 3.4 3.5 Assisted Living Facility Nursing Home Skilled Nursing Facility Diagnostic Services Dialysis Center Drug and/or Alcohol Rehabilitation Facility Mental Health Facility Other Recurring Care Center Physical Rehabilitation Facility Nursing Home/Assisted Living Facility PUBLIC HEALTH DIVISION EMS and Trauma Systems 34

eDisposition.23 Hospital Capability* 3.4 3.5 Stroke-Acute Stroke Ready Hospital (ASRH) Stroke-Primary Stroke Center (PSC) Stroke-Thrombectomy-Capable Stroke Center (TSC) Stroke-Comprehensive Stroke Center (CSC) Cancer Center Labor and Delivery Stroke Center * NEMSIS 3.5 also adds the ability to record more than one value for Hospital Capability on a PCR. PUBLIC HEALTH DIVISION EMS and Trauma Systems 35

eDisposition.24 Destination Team Pre- Arrival Alert or Activation 3.5 Yes-Sepsis PUBLIC HEALTH DIVISION EMS and Trauma Systems 36

Validation Rules Many validation rules were modified for NEMSIS 3.5 to support the new disposition elements, but for the most part they enforce the same constraints. Oregon has added two significant new warnings: On-Scene Odometer Reading of Responding Vehicle should be recorded when Transport Disposition is "Transport by This EMS Unit...". Patient Destination Odometer Reading of Responding Vehicle should be recorded when Transport Disposition is "Transport by This EMS Unit...". If you use trip odometers or only record the number of miles transported, you can auto-fill the On-Scene Odometer Reading to 0 and then record the number of miles transported in Patient Destination Odometer Reading. PUBLIC HEALTH DIVISION EMS and Trauma Systems 37

Action List Coordinate with data exchange partners Possible impact on data imports (CAD) New version for data exports (billing, hospital, etc.) Deploy validation rules Update agency demographic information Update PCR data entry forms Train personnel New data elements and values New validation rules Update analytical report designs Update incident list views Update CQI configuration PUBLIC HEALTH DIVISION EMS and Trauma Systems 38