Training

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.