Training

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