NEMSIS Educational Snip

Greetings Everyone,

The weekly data snippet for this week

NYS NEMSIS 3.5.0 | Educational Snip #2024-009 

The 2024 Vital Signs EMS Conference is taking place in Rochester from October 16^th to the 20^th.  Register here and stop by our booth to say hi! Next week, due to the conference, the DI Unit will not be sending an educational snip. 

The Data and Informatics (DI) Unit at the Bureau of EMS & Trauma Systems is sending weekly Educational Snips highlighting various NEMSIS fields. Our goal is to help providers reduce documentation errors and warnings requiring adjustment throughout documentation. Each Educational Snip will start with a question, an outline of various fields, and elements (answers) within those fields. We are providing the NEMSIS named elements; the ePCR software used by your EMS agency might look different, and you should have custom values selected by the Department of Health available to you. If you have questions about specific documentation scenarios or if you would like clarification on particular data elements, please reach out to your organization’s leadership, Regional Program Agencies, or the DI Unit.   

EMS agencies credentialed by New York State are now submitting ePCRs that adhere to the National Emergency Medical Services Information System (NEMSIS) 3.5 documentation standard. NEMSIS establishes a minimum documentation standard that requires fields that must be completed on an ePCR and NYS further defines these requirements to meet minimal additional requirements. Standardized documentation improves quality documentation. Measuring provider effectiveness, system efficiency, and patient outcomes is paramount to the success of EMS organizations across New York State.  

Q: How have medication fields changed under NEMSIS 3.5? 

Some element names and descriptions were changed. Response values were added/removed from three fields and 2009 standard names were removed.  

Note: all fields are named by NEMSIS with the Field Name (Field Identifier) (e.g. EMS Agency Number (eResponse.01)) 

Medication Administered (eMedications.03, BLSFR 2472 ALFR & Transporting 2473) 

This is a required field when a medication is administered. The list of medications has been updated to include codes for blood products. The inclusive list can be found here. Pertinent negatives are also available for this field including:  

• Contraindication noted 
• Denied by order 
• Medication allergy 
• Medication already taken 
• Refused 
• Unable to complete 
• Order criteria not met 

Medication Administered Route (eMedications.04, BLSFR 2474 ALSFR & Transporting 2475) 

This is a required field when a medication is administered. The list was updated to enhance accuracy of documentation:  

Blow-by	Re-breather mask
Buccal	Rectal
Endotracheal Tube (ET)	Subcutaneous
Gastrostomy Tube	Sublingual
Inhalation	Topical
Intraarterial	Tracheostomy
Intradermal	Transdermal
Intramuscular (IM)	Urethral
Intranasal	Venti mask
Intraosseous (IO)	Wound
Intravenous (IV)	Porta Cath
Nasal Cannula	Auto Injector
Nasogastric	BVM
Nasotracheal Tube	CPAP
Non-Rebreather Mask	IV Pump
Opthalmic	Nebulizer
Oral	Umbilical Artery Catheter
Other/Miscellaneous	Umbilical Venous Catheter
Otic

Medication Dosage Units (eMedications.06, BLSFR 2555 ALSFR & Transporting 2556)  

This field is required when a medication is administered. Values have been removed and added to the list to enhance accuracy:  

Grams (gms)	Other
Inches (in)	Centimeters (cm)
International Units (IU)	Drops (ggts)
Keep Vein Open (KVO)	Liters per Minute (LPM)
Liters (L)	Micrograms per Minute (mcg/min)
Metered Dose (MDI)	Milligrams per Kilogram (mg/kg)
Micrograms (mcg)	Milligrams per Minute (mg/min)
Micrograms per Kilogram per Minute (mcg/kg/min)	Puffs
Milliequivalents (mEq)	Units per Hour (units/hr)
Milligrams (mg)	Micrograms per Kilogram (mcg/kg)
Milligrams per Kilogram per Minute (mg/kg/min)	Units
Milliliters (ml)	Units per Kilogram per Hour (units/kg/hr)
Milliliters per Hour (ml/hr)	Units per Kilogram (units/kg)
	Milligrams per Hour (mg/hr)

Role/Type of Person Administering Medication (eMedications.10, BLSFR 2735 ALSFR & Transporting 2736)

 This field is required when a medication is administered. The list of roles has been updated to be more reflective of current State needs. The “2009” standard names have been removed.

NYS Certified Paramedic	The Patient or Any Lay Person Not Otherwise Specified
NYS Certified First Responder (CFR)	Respiratory Therapist
NYS Certified EMT – Critical Care (EMT-CC)	Registered Nurse
NYS Certified Emergency Medical Technician (EMT)	Physician Assistant
NYS Certified Advanced EMT (AEMT)	Physician
Nurse Practitioner	Perfusionist
Licensed Practical Nurse (LPN)	Other Non-Healthcare Professional
CT Technologist
Any Provider Acting in the Capacity of an EMS Student
Any Person Not Otherwise Specified (Not CFR)
Any Healthcare Provider Acting Under their Own (Non-EMS) License

 

Please see the latest Educational Snip from the Bureau of EMS Data and Informatics Team

The 2024 Vital Signs EMS Conference is taking place in Rochester from October 16^th to the 20^th.  Register here and stop by our booth to say hi! Of note, the week of the conference, the DI Unit will not be sending an educational snip. 

The Data and Informatics (DI) Unit at the Bureau of EMS & Trauma Systems is sending weekly Educational Snips highlighting various NEMSIS fields. Our goal is to help providers reduce documentation errors and warnings requiring adjustment throughout documentation. Each Educational Snip will start with a question, an outline of various fields, and elements (answers) within those fields. We are providing the NEMSIS named elements; the ePCR software used by your EMS agency might look different, and you should have custom values selected by the Department of Health available to you. If you have questions about specific documentation scenarios or if you would like clarification on particular data elements, please reach out to your organization’s leadership, Regional Program Agencies, or the DI Unit.   

EMS agencies credentialed by New York State are now submitting ePCRs that adhere to the National Emergency Medical Services Information System (NEMSIS) 3.5 documentation standard. NEMSIS establishes a minimum documentation standard that requires fields that must be completed on an ePCR and NYS further defines these requirements to meet minimal additional requirements. Standardized documentation improves quality documentation. Measuring provider effectiveness, system efficiency, and patient outcomes is paramount to the success of EMS organizations across New York State.  

Q: How are scene fields documented under NEMSIS 3.5? 

NYS has worked to decrease the amount of validation rules resulting in failures; however, scene fields are vital for accurate documentation and system assessment. The DI unit has noticed many validation failures due to the Incident City field. This snip describes the scene fields that are required. 

Note: all fields are named by NEMSIS with the Field Name (Field Identifier) (e.g. EMS Agency Number (eResponse.01)) 

Incident Location Type (eScene.09) 

This field is required by NYS for ALSFR/Transporting agencies (validation rule 2622). The list of location types is below.  

• Private residence 
• Nursing home 
• Public area (not otherwise specified) 
• Street/road/highway 
• Urgent care 
• Hospital  
• Doctor’s office 
• Apartment/condo 
• Industrial/construction area 
• Institutional residence 
• Other private residence 
• Other, (not otherwise specified) 
• Parking lot 
• Place of business, (not otherwise specified) 
• Restaurant/cafe 
• School 
• Sidewalk 
• Sports area 
• Warehouse 
• Daycare 
• Abandoned house 
• Airport 
• Military installation 
• Mobile home 
• Other ambulatory care 
• Recreational area, (not otherwise specified) 
• Clubhouse 
• Gym 
• Prison/jail 
• Store 
• Public building 
• Park  
• Religious institution 
• School dorm 
• Pool 

Incident Facility Code (eScene.10) 

This field is required by NYS for ALSFR/Transporting agencies (validation rule 2835). Each facility name/label might appear different based on your software vendor, or your agencies needs. NYS has required codes for hospitals and skilled nursing facilities that are required for care transported to or from one of these facility types. 

Incident Street Address (eScene.15) 

This field is required by NYS for BLSFR and ALSFR/Transporting agencies (validation rules 2623, 2624, 2625, 2626). Not values are not accepted for this field. If the secondary address is filled out without the primary address line being completed, the validation will fail.  

Incident City (eScene.17) 

This field is required by NYS for BLSFR and ALSFR/Transporting agencies (validation rules 2627, 2628) when a unit responding to scene time is documented. Not values are not accepted.  

Incident State (eScene.18) 

This field is required by NYS for BLSFR and ALSFR/Transporting agencies (validation rules 2727, 2728) when a unit responding to scene time is documented. Not values are not accepted.  

Incident Zip (eScene.19) 

This field is required by NYS for BLSFR and ALSFR/Transporting agencies (validation rules 2629, 2630). Not values are not accepted.  

Incident County (eScene.21) 

This field is required by NYS for BLSFR and ALSFR/Transporting agencies (validation rules 2631, 2632). Not values are not accepted. 

Incident Country (eScene.22) 

This field is required by NYS for BLSFR and ALSFR/Transporting agencies (validation rules 2725, 2726). Not values are not accepted. 

Greetings,

See this weeks NEMSIS Educational Snip:

The Data and Informatics (DI) Unit at the Bureau of EMS & Trauma Systems is sending weekly Educational Snips highlighting various NEMSIS fields. Our goal is to help providers reduce documentation errors and warnings requiring adjustment throughout documentation. Each Educational Snip will start with a question, an outline of various fields, and elements (answers) within those fields. We are providing the NEMSIS named elements; the ePCR software used by your EMS agency might look different, and you should have custom values selected by the Department of Health available to you. If you have questions about specific documentation scenarios or if you would like clarification on particular data elements, please reach out to your organization’s leadership, Regional Program Agencies, or the DI Unit.   

  

EMS agencies credentialed by New York State are now submitting ePCRs that adhere to the National Emergency Medical Services Information System (NEMSIS) 3.5 documentation standard. NEMSIS establishes a minimum documentation standard that requires fields that must be completed on an ePCR and NYS further defines these requirements to meet minimal additional requirements. Standardized documentation improves quality documentation. Measuring provider effectiveness, system efficiency, and patient outcomes is paramount to the success of EMS organizations across New York State.  

  

The DI Unit is holding monthly NEMSIS 3.5 ePCR briefings via Webex. In these briefings, issues that EMS agencies commonly face regarding patient care documentation will be addressed. EMS providers will have the opportunity to ask any questions or raise any concerns about 3.5 submission criteria they wish. Feedback from these briefings is vital for their ongoing success. If you are an EMS provider, an EMS leader, an EMS medical director, or a software vendor who attends these meetings, please fill out a survey through this link, under the ‘Data’ section of the page.  

 

Q: How has documentation of procedures (eProcedures) changed under NEMSIS 3.5? 

Many response elements were changed across procedure fields. 

Note: all fields are named by NEMSIS with the Field Name (Field Identifier) (e.g. EMS Agency Number (eResponse.01))  

 

Date/Time Procedure Performed (eProcedures.01, validation rule BLSFR 2582/ALSFR & Ambulance 2583) 

When a procedure is performed, this field is required by NYS. It triggers additional required fields listed below.  

 

Procedure Performed Prior to this Unit’s EMS Care (eProcedures.02, ALSFR & Ambulance 2585) 

This field is recommended by NYS. Response elements include “yes” and “no”. The date and time of the procedure cannot be prior to arrival at the patient unless this is answered “yes”.  

 

Procedure (eProcedures.03, BLSFR 2586/ALSFR & Ambulance 2587) 

This field is required by NYS when Date/Time Procedure Performed is documented. To view the entire list of procedures, visit New York – NEMSIS and download the data dictionary excel file.  

 

Number of Procedure Attempts (eProcedures.05, BLSFR 2588/ALSFR & Ambulance 2589) 

This field is required by NYS when procedures are performed by crew members of unit caring for patient. This field numbers between 1 through 10.  

 

Procedure Successful (eProcedures.06, BLSFR 1238/ALSFR & Ambulance 1239) 

This field is required by NYS when a procedure is attempted on the patient. The response options for this field are “Yes” and “No”. 

 

Procedure Complication (eProcedures.07, BLSFR 2592/ALSFR & Ambulance 2593) 

This field is recommended (especially for ALS/Transporting units) by NYS when procedures are performed by crew members of unit caring for patient. Response values are listed below. Note, if there is no complication one should respond “none” instead of using a not value like “not applicable”.  

·       Altered Mental Status 

·       Apnea 

·       Bleeding 

·       Bradypnea 

·       Diarrhea 

·       Esophageal Intubation-immediately 

·       Esophageal Intubation-other 

·       Extravasation 

·       Hypertension  

·       Hyperthermia 

·       Hypotension 

·       Hypothermia 

·       Hypoxia 

·       Injury 

·       Nausea 

·       None 

·       Other 

·       Respiratory Distress 

·       Tachycardia 

·       Vomiting 

·       Bradycardia 

·       Itching 

·       Urticaria 

 

Response to Procedure (eProcedures.08, BLSFR 2594/ALSFR & Ambulance 2595) 

This field is recommended (especially for ALS/Transporting units) by NYS when procedures are performed by crew members of unit caring for patient. Response elements include “Improved”, “Unchanged”, and “Worse”.  

 

Procedure Authorization (eProcedures.11, BLSFR 2596/ALSFR & Ambulance 2597) 

This field is required by NYS. Response elements listed below.  

·       On-Line (Remote Verbal Order) 

·       On-Scene 

·       Protocol (Standing Order) 

·       Written Orders (Patient Specific) 

 

Procedure Authorizing Physician (eProcedures.12, BLSFR 2598/ALSFR & Ambulance 2599) 
This field is required by NYS when a procedure was authorized outside of standing orders. It is a free text field.  

 

Vascular Access Location (eProcedures.13, ALSFR & Ambulance 2620) 

This field is recommended by NYS when vascular access is obtained. It is now associated with the date and time of the procedure and allows documentation for each attempt at vascular access. EMS professionals can also document when a patient received vascular access prior to arrival of EMS. Options have been added to this field. All elements are listed below.  

·       Antecubital Left 

·       Antecubital-Right 

·       External Jugular-Left 

·       External Jugular-Right 

·       Femoral Left IV 

·       Femoral-Right IV 

·       Foot-Right 

·       Foot-Left 

·       Forearm-Left 

·       Forearm-Right 

·       Hand-Left 

·       Hand-Right 

·       Internal Jugular-Left 

·       Internal Jugular-Right 

·       IO-Iliac Crest-Left 

·       IO-Iliac Crest-Right 

·       IO-Femoral-Left Distal 

·       IO-Femoral-Right Distal 

·       IO-Humeral-Left 

·       IO-Humeral-Right 

·       IO-Tibia-Left Distal 

·       IO-Sternum 

·       IO-Tibia-Right Distal 

·       IO-Tibia-Left Proximal 

·       IO-Tibia-Right Proximal 

·       Lower Extremity-Left 

·       Lower Extremity-Right 

·       Other Peripheral 

·       Other Central (PICC, Portacath, etc.) 

·       Scalp 

·       Subclavian Left 

·       Subclavian-Right 

·       Umbilical 

·       Venous Cutdown-Left Lower Extremity 

·       Venous Cutdown-Right Lower Extremity 

·       Upper Arm-Left 

·       Upper Arm-Right 

·       Radial-Left 

·       Radial-Right 

·       Wrist-Left 

Greetings Everyone,

Please see this weeks NEMSIS mini-education snapshot:

NYS NEMSIS 3.5.0 | Educational Snip #2024-007

The Data and Informatics (DI) Unit at the Bureau of EMS & Trauma Systems is sending weekly Educational Snips highlighting various NEMSIS fields. Our goal is to help providers reduce documentation errors and warnings requiring adjustment throughout documentation. Each Educational Snip will start with a question, an outline of various fields, and elements (answers) within those fields. We are providing the NEMSIS named elements; the ePCR software used by your EMS agency might look different, and you should have custom values selected by the Department of Health available to you. If you have questions about specific documentation scenarios or if you would like clarification on particular data elements, please reach out to your organization’s leadership, Regional Program Agencies, or the DI Unit.

EMS agencies credentialed by New York State are now submitting ePCRs that adhere to the National Emergency Medical Services Information System (NEMSIS) 3.5 documentation standard. NEMSIS establishes a minimum documentation standard that requires fields that must be completed on an ePCR and NYS further defines these requirements to meet minimal additional requirements. Standardized documentation improves quality documentation. Measuring provider effectiveness, system efficiency, and patient outcomes is paramount to the success of EMS organizations across New York State.

The DI Unit is holding monthly NEMSIS 3.5 ePCR briefings via Webex. In these briefings, issues that EMS agencies commonly face regarding patient care documentation will be addressed. EMS providers will have the opportunity to ask any questions or raise any concerns about 3.5 submission criteria they wish. Feedback from these briefings is vital for their ongoing success. If you are an EMS provider, an EMS leader, an EMS medical director, or a software vendor who attends these meetings, please fill out a survey through this link, under the ‘Data and Informatics’ section of the page.

Q: How has documentation of eSituation fields changed from NEMSIS 3.4 to NEMSIS 3.5?

6 elements were changed from NEMSIS 3.4 to NEMSIS 3.5. 5 of the elements are Required in New York State and 1 is a Recommended element.

Note: all fields are named by NEMSIS with the Field Name (Field Identifier) (e.g. EMS Agency Number (eResponse.01))

Date/Time of Symptom Onset (eSituation.01, validation rule 1365)

This is a required field in NYS and must be documented for each symptom recorded. In NEMSIS 3.5, new values were added to this field for Pertinent Negatives: ‘Unable to Complete’ and ‘Approximate’. The format of the date is as follows: mm/dd/yyyy. The format of the time is as follows: hh:mm:ss.

Initial Patient Acuity (eSituation.13, validation rule 1377)

This is a required field in NYS. A new value was added to this field. The list of values for this field is shown below:

• Critical (Red)
• Emergent (Yellow)
• Lower Acuity (Green)
• Dead Without Resuscitation Efforts (Black)
• Non-Acute/Routine

Date/Time Last Known Well (eSituation.18, validation rule 1378)

This is a required field in NYS when primary impression is CVA, which stands for Cerebral Vascular Accident, or TIA, which stands for Transient Ischemic Attack. In NEMSIS 3.5, a new Pertinent Negative was added: Unable to Complete

Justification for Transfer or Encounter (eSituation.19)

This field is recommended in NYS. It is a new element released with NEMSIS 3.5. This should only be documented when Type of Service Requested (eResponse.05) is Hospital-to-Hospital Transfer, Hospital-to-Hospital Transfer (with Sending Hospital Staff), Hospital-to-Hospital Transfer (Critical or Specialty Care), Other Medical Needs Transport, or Mobile Integrated Health Care Evaluation or Visit.

 

Reason for Interfacility Transfer/Medical Transport (eSituation.20)

This is a national field. There is no validation rule requiring it in NYS. New elements were added in NEMSIS 3.5. The full list is shown below:

• Cardiac Specialty
• Convenience Transfer (Patient Request)
• Diagnostic Testing
• Dialysis
• Drug and/or Alcohol Rehabilitation Care
• Extended Care
• Maternal/Neonatal
• Medical Specialty Care (Other, Not Listed)
• Neurological Specialty Care
• Palliative/Hospice Care (Home or Facility)
• Pediatric Specialty Care
• Psychiatric/Behavioral Care
• Physical Rehabilitation Care
• Return to Home/Residence
• Surgical Specialty Care (Other, Not Listed)
• Trauma/Orthopedic Specialty Care

Greetings Everyone

From the State:

NYS NEMSIS 3.5.0 | Educational Snip #2024-002

The Data and Informatics (DI) Unit at the Bureau of EMS & Trauma Systems is sending weekly Educational Snips highlighting various NEMSIS fields. Our goal is to help providers reduce documentation errors and warnings requiring adjustment throughout documentation by getting ahead of them. Each Educational Snip will start with a question, an outline of various fields, and elements (answers) within those fields. We are providing the NEMSIS named elements; the ePCR software used by your EMS agency might look different, and you should have custom values selected by the Department of Health available to you. If you have questions about specific documentation scenarios or if you would like clarification on particular data elements, please reach out to your organization’s leadership, Regional Program Agencies, or the DI Unit.

EMS agencies credentialed by New York State are now submitting ePCRs that adhere to the National Emergency Medical Services Information System (NEMSIS) 3.5 documentation standard. NEMSIS establishes a minimum documentation standard that requires fields that must be completed on an ePCR and NYS further defines these requirements to meet minimal additional requirements. Standardized documentation improves quality documentation. Measuring provider effectiveness, system efficiency, and patient outcomes is paramount to the success of EMS organizations across New York State.

The DI Unit will be holding monthly NEMSIS 3.5 ePCR briefings via Webex. In these briefings, issues that EMS agencies commonly face will be addressed. EMS providers will have the opportunity to ask any questions or raise any concerns about 3.5 submission criteria they wish. Feedback from these briefings are vital for their ongoing success. If you are an EMS provider, an EMS leader, an EMS medical director, or a software vendor who attends these meetings, please fill out a survey through this link. Choose the ‘Data and Informatics’ option in the filter list, then under the ‘Surveys’ section of the page choose the survey link which applies to you.

 

Q: How has the documentation of trauma elements changed from NEMSIS 3.4 to NEMSIS 3.5?

Note:  all fields are named by NEMSIS with the Field Name (Field Identifier) (e.g. Incident / Patient Disposition (eDisposition.12)

Trauma element names were changed, and new values were added to reflect the 2021 American College of Surgeons National Guideline for the Field Triage of Injured Patients

• Trauma Center Criteria (eInjury.03) is now Trauma Triage Criteria (Steps 1 and 2)
• Vehicular, Pedestrian, or Other Injury Risk Factor (eInjury.04) is now Trauma Triage Criteria (Steps 3 and 4)

 

Important: eInjury.03 and eInjury.04 MUST be documented, when Possible Injury (eSituation.02) is “Yes.” Otherwise, these elements should not be recorded. Pertinent negatives are acceptable.

Trauma Triage Criteria (Steps 1 and 2) eInjury.03 – High Risk for Serious Injury

21 response options and is required by NYS. If you report that the patient has a possible injury, then “not applicable” is NOT an appropriate answer to the risk factor list. In other words, you must triage your patient for trauma criteria when they are injured, and thus if they lack any high-risk factors for serious injury in the list below the appropriate answer is a pertinent negative: “none reported”.

• Amputation proximal to wrist or ankle
• Crushed, degloved, mangled, or pulseless extremity
• Chest wall instability, deformity, or suspected flail chest
• Skull deformity, suspected skull fracture
• Suspected pelvic fracture
• Penetrating injuries to head, neck, torso, and proximal extremities
• Respiratory Rate <10 or >29 breaths per minute (<20 in infants aged <1 year) or need for ventilatory support
• Suspected fracture of two or more proximal long bones
• Active bleeding requiring a tourniquet or wound packing with continuous pressure
• Age >= 10 years: HR > SBP
• Age >= 65 years: SBP < 110 mmHg
• Age 0-9 years: SBP < 70 mmHg + (2 x age in years)
• Age 10-64 years: SBP < 90 mmHg
• Respiratory distress or need for respiratory support
• Room-air pulse oximetry < 90%
• RR < 10 or > 29 breaths/min
• Suspected spinal injury with new motor or sensory loss
• Unable to follow commands (motor GCS < 6)

Trauma Triage Criteria (Steps 3 and 4) eInjury.04 – Moderate Risk for Serious Injury

20 response options and is required by NYS. Again, when you answer “yes” to “Possible Injury”, you must report whether your patient has any moderate risks for serious injury. If they lack any of the options listed below, the appropriate pertinent negative is “none reported”.

• Pedestrian/bicycle rider thrown, run over, or with significant impact.
• Auto Crash: Death in passenger compartment
• Auto Crash: Partial or complete ejection
• Auto Crash: Significant intrusion (including roof): > 12 inches occupant site; > 18 inches any site; need for extrication
• Auto Crash: Vehicle telemetry data consistent with severe injury
• Vehicle v. Pedestrian or Motorcycle Crash > 20 MPH
• SBP < 110 for age > 65
• Anticoagulant use
• Pregnancy > 20 weeks
• Other EMS judgement
• Burns in conjunction with trauma
• Auto Crash: Child (age 0-9 years) unrestrained or in unsecured child safety seat
• Fall from height > 10 feet (all ages)
• Low-level falls in young children (age<=5 years) or older adults (age>=65 years) with significant head impact
• Rider separated from transport vehicle with significant impact (eg, motorcycle, ATV, horse, etc.)
• Special, high-resource healthcare needs
• Suspicion of child abuse

Additional Information on the American College of Surgeons Trauma Triage Criteria can be found through the American College of Surgeons website: Field Triage Guidelines | ACS (facs.org)

On ACS Website: Red Criteria pertains to eInjury.03 and Yellow Criteria pertains to eInjury.04.