The assessment of the patients left upper abdomen on examination Normal Not Done Distention Guarding Mass Tenderness The assessment of the patients left lower abdomen on examination Normal Not Done Distention Guarding Mass Tenderness The assessment of the patients right lower abdomen on examination Normal Not Done Distention Guarding Mass Tenderness The assessment of the patients right upper abdomen on examination Normal Not Done Distention Guarding Mass Tenderness The presence of a valid for of living will of document directing end of life or healthcare treatment decisions State/EMS DNR Form Other Healthcare DNR Form Living Will Family/Guardian request DNR (but no documentation) Other None The mode of operation the device is operating in during the defibrillation, pacing, or rhythm analysis by the device (if appropriate for the event) Automated Manual Advisory Demand Sensing Mid-Stream Side-Stream The patient's age (either calculated from date of birth or best approximation) county or parish or residence The primary medical speciality of the Agency Medical Director. Anesthesiology Cardiology Emergency Medicine Family Practice General Practice (not board certified) Internal Medicine Obstretrics and Gynecology Orthopedics Other Pediatrics Surgery The patient's home state, territory, or province, or District of Columbia, where the patient resides The units which the age is documented in (Hours, Days, Months, Years) Hours Days Months Years IndicationOfAirbagDeployment No Airbag Present No Airbag Deployed Airbag Deployed Front Airbag Deployed Side Airbag Deployed Other (knee, airbelt,etc.) Indicators for the potential use of Alcohol or Drugs by the patient. Smell of Alcohol on Breath Patient Admits to Alcohol Use Patient Admits to Drug Use Alcohol and/or Drug Paraphernalia at Scene None The mileage (odometer reading) of the vehicle rounded to the nearest mile The patient's total APGAR score (0-10) Recommend to be taken at 1 and 5 minutes after the infants birth The area or location of impact on the vehicle Center Front Center Rear Left Front Left Rear Left Side Right Front Right Rear Right Side Roll Over Indication of who the cardiac arrest was witnessed by Witnessed by Healthcare Provider Witnessed by Lay Person Not Witnessed The assessment of the patients back-cervical on examination Normal Not Done Pain to ROM Tender Para-spinous Tender Spinous Process The assessment of the patients back-lumbar/sacral on examination Normal Not Done Pain to ROM Tender Para-spinous Tender Spinous Process The assessment of the patients back-thoracic on examination Normal Not Done Pain to ROM Tender Para-spinous Tender Spinous Process Indication of whether or not there were any patient specific barriers to serving the patient at the scene Developmentally Impaired Hearing Impaired Language None Physically Impaired Physically Restrained Speech Impaired Unattended or Unsupervised (including minors) Unconscious Indication of whether the EMS agency routinely bills for any segment of the patient population Yes No The Patients blood glucose level The Patients body temperature in Centigrade The Broselow/Luten Color as taken from the tape Blue Green Grey Orange Pink Purple Red White Yellow The number of 911 EMS called per year based on last calendar year. Indication of the presence of a cardiac arrest at any time. Yes, Prior to EMS Arrival Yes, After EMS Arrival No Indication of the etiology or cause of the cardiac arrest (classified as cardiac, non-cardiac, etc.) (Utstein #5) Presumed Cardiac Trauma Drowning Respiratory Electrocution Other The initial cardiac rhythm of the patient as interpreted by EMS personnel 12 Lead ECG-Anterior Ischemia 12 Lead ECG-Inferior Ischemia 12 Lead ECG-Lateral Ischemia Agonal/Idioventricular Artifact Asystole Atrial Fibrillation/Flutter AV Block-1st Degree AV Block-2nd Degree-Type 1 AV Block-2nd Degree-Type 2 AV Block-3rd Degree Junctional Left Bundle Branch Block Normal Sinus Rhythm Other Paced Rhythm PEA Premature Atrial Contractions Premature Ventricular Contractions Right Bundle Branch Block Sinus Arrhythmia Sinus Bradycardia Sinus Tachycardia Supraventricular Tachycardia Torsades De Points Unknown AED Non-Shockable Rhythm Unknown AED Shockable Rhythm Ventricular Fibrillation Ventricular Tachycardia The patient's cardiac rhythm upon delivery or transfer to the destination 12 Lead ECG-Anterior Ischemia 12 Lead ECG-Inferior Ischemia 12 Lead ECG-Lateral Ischemia Agonal/Idioventricular Artifact Asystole Atrial Fibrillation/Flutter AV Block-1st Degree AV Block-2nd Degree-Type 1 AV Block-2nd Degree-Type 2 AV Block-3rd Degree Junctional Left Bundle Branch Block Normal Sinus Rhythm Other Paced Rhythm PEA Premature Atrial Contractions Premature Ventricular Contractions Right Bundle Branch Block Sinus Arrhythmia Sinus Bradycardia Sinus Tachycardia Supraventricular Tachycardia Torsades De Points Unknown AED Non-Shockable Rhythm Unknown AED Shockable Rhythm Ventricular Fibrillation Ventricular Tachycardia The category of the reported/suspected external cause of the injury. AIrcraft Related Accident (E84X.0) Bicycle Accident (E826.0) Bites (E906.0) Chemical Poisoning (E86X.0) Child Battering (E967.0) Drowning (E910.0) Drug Posoning (E85X.0) Electrocution (non-lightning) (E925.0) Excessive Cold (E901.0) Excessive Heat (E900.0) Falls (E88X.0) Fire and Flames (E89X.0) Firearm Assult (E965.0) Firearm Injury (accidental) (E985.0) Firearm self inflected (E955.0) Lightning (E907.0) Machinery Accidents (E919.0) Mechanical Suffocation (E913.0) Motor Vehicle non-traffic accident (E82X.0) Motor Vehicle traffic accident (E81X.0) Motorcycle Accident (E81X.0) Non-Motorized Vehicle Accident (E848.0) Pedestrian Traffic Accident (E814.0) Radition Exposure (E926.0) Rape (E960.1) Smoke Inhalation (E89X.2) Stabbing/Cutting Accidental (E986.0) Stabbing/Cutting Assultl (E966.0) Struck by Blunt/Thrown Object (E968.2) Venomus stings (plants, animals) (E905.0) Water Transport accident (E83X.0) The assessment of the patients chest on examination Normal Not Done Accessory Muscles Decreased BS-Left Decreased BS-Right Flail Segment-Left Flail Segment-Right Increased Effort Normal BS Rales Rhonchi/Wheezing Tenderness-Left Tenderness-Right The statement of the problem by the patient or the history provider. The patient's home city or township or residence The relationship of the patient's closest relative or guardian Appointed Guardian Father Mother Other Son/Daughter Spouse The CMS service level for this EMS encounter. BLS BLS, Emergency ALS, Level 1 ALS, Level 1 Emergency ALS, Level 2 Paramedic Intercept Specialty Care Transport Fixed Wing (Airplane) Rotary Wing (Helicopter) The Patients end-tidal or other CO2 level The primary anatomic location of the chief complaint as identified by EMS personnel Abdomen Back Chest Extremity-Lower Extremity-Upper General/Global Genitalia Head Neck The 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 Cardiovascular CNS/Neuro Endocrine/Metabolic GI Global Musculoskeletal OB/Gyn Psych Pulmonary Renal Skin The complaint dispatch reported to the responding unit. Abdominal Pain Allergies Animal Bite Assult Back Pain Breathing Problem Burns CO Poisoning/Hazmat Cardiac Arrest Chest Pain Choking Convulsions/Seizure Diabetic Problem Drowning Electrocution Eye Problem Fall Victim Headache Heart Problems Heat/Cold Exposure Hemorrage/Laceration Industrial Accident/Inaccessible Incident/Other Entrapments (non-vehicle) Ingestion/Poisoning Pregnacy/Childbirth Psychiatric Problem Sick Person Stab/Gunshot Wound Stroke/CVA Traffic Accident Traumatic Injury Unconscious/Fainting Unknown Problem Man Down Transfer/Interfacility/Palliative Care MCI The CMS Condition Code Air Ambulance Modifier indicating why it was medically necessary to respond with air medical services as opposed to ground medical services. A-Interfacility Transport (Requires Higher level of care) B-Interfacility Transport (service not available) C-ALS Response to BLS Patient D-Medically Necessary Transport (Not Nearest Facility) E-BLS Transport of ALS PAtient F-Emergency Trauma Dispatch Condition Code (patient is BLS) Air-A-Long Distance Air-B- Traffic Precludes Ground Transport Air-C-Time Precludes Ground Transport Air-D-Pick up Point not Accessible by Ground Transport The condition code associated with the CMS EMS negotiated rule-making process. Severe Abdominal Pain (ALS-789.00) Abdominal Pain (ALS-789.00) Abnormal Cardiac Rhythm/Cardiac Dysrhythmia (ALS-427.9) Abnormal Skin Signs (ALS-780.8) Abnormal Vital Signs (ALS-796.4) Allergic Reaction (ALS-995.0) Allergic Reaction (BLS-692.9) Blood Glucose (ALS-790.21) Respiratory Arrest (ALS-799.1) Difficulty Breathing (ALS-786.05) Cardiac Arrest_Resuscitation in Progress (ALS-427.5) Chest Pain (Non-Traumatic) (ALS-786.50) Choking Episode (ALS-784.9) Cold Exposure (ALS-991.6) Cold Exposure (BLS-991.6) Altered Level of Consciousness (non-traumatic) (ALS-780.01) Convulsions/Seizures (ALS-780.39) Eye Symptoms (non-traumatic) (BLS-379.90) Non Traumatic Headache (ALS-437.9) Cardiac Symptoms other than Chest Pain (palpitations) (ALS-785.1) Cardiac Symptoms othe than Chest Pain (atypical pain) (ALS-536.2) Heat Exposure (ALS-992.2) Heat Exposure (BLS-992.2) Hemorrage (ALS-459.0) Infectious Diseases requiring Isolation/Public Health Risk (BLS-038.9) Hazmat Exposure (ALS-987.9) Medical Device Failure (ALS-996.0) Medical Device Failure (BLS-996.3) Neurologic Distress (ALS-436.0) Pain (Severe) (ALS-780.99) Back Pain (non-traumatic possible cardiac or vascular) (ALS-724.5) Back Pain (non-traumatic with neurologic symptoms) (ALS-724.9) Posions (all routes) (ALS-977.9) Alcohol Intoxication or Drug Overdose (BLS-305.0) Severe Alcohol Intoxication (ALS-977.3) Post-Operative Procedure COmplications (BLS-998.9) Pregnacy Complication/Chlidbirth/Labor (ALS-650.0) Psychiatric/Behavioral (abnormal mental status) (ALS-292.9) Psychiatric/Behavioral (threat to self or others) (BLS-298.9) SIck Person-Fever (BLS-036.9) Severe Dehydration (ALS-787.01) Unconscious/Syncope/Dizziness (ALS-780.02) Major Trauma (ALS-959.8) Other Trauma (need for monitor or airway) (ALS-518.5) Other Trauma (major bleeding) (ALS-958.2) Other Trauma (fracture/dislocation (BLS-829.0) Other Trauma (penetrating extremity) (BLS-880.0) Other Trauma (amputation digits) (BLS-886.0) Other Trauma (amputation other) (ALS-887.4) Other Trauma (suspected internal injuries) (ALS-869.0) Burns-Major (ALS-949.3) Burns-Minor (BLS-949.2) Animal Bites/Sting/Envenomation (ALS-989.5) Animal Bites/Stings/Envenomation (BLS-879.8) Lightning (ALS-994.0) Electrocution (ALS-994.8) Near Drowning (ALS-994.1) Eye Injuries (BLS-921.9) Sexual Assault (major injuries) (ALS-995.83) Sexual Assault (minor injuries) (BLS-995.8) Cardiac/Hemodynamic Monitoring Required (ALS-428.9) Advanced Airway Management (ALS-518.81) IV Meds Required (ALS-No ICD code provided) Chemical Restraint (ALS-293.0) Suctioning/Oxygen/IV fluids required (BLS-496.0) Airway Control/Positioning Required (BLS-786.09) Third Party Assistance/Attendant Required (BLS-496.0) Patient Safety (restraints required) (BLS-298.9) Patient Safety (monitoring required) (BLS-293.1) Patient Safety (seclusion required) (BLS-298.8) Patient Safety (risk of falling off stretcher) (BLS-781.3) Special Handling (Isolation) (BLS-041.9) Special Handling (orthopedic device required) (BLS-907.2) Special Handling (positioning required) (BLS-719.45) The condition of the patient after care by EMS Improved Unchanged Worse country of citizenship county or parish or residence The State Certification/Licensure ID number assigned to the crew member The functioning level of the crew member during this EMS patient encounter Student Other Healthcare Professional Other Non-Healthcare Professional The 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 the Primary and Secondary Patient Care Givers. Driver Primary Patient Caregiver Secondary Patient Caregiver Third Patient Caregiver Other The administration route (po, SQ, etc.) of the patients current medication Endotracheal tube Gastronomy tube Inhalation Intramuscular Intranasal Intraocular Intraosseous Intravenous Nasal Nasal prongs Nasogastric Ophthalmic Oral Other/miscellaneous Otic Re-breather mask Rectal Subcutaneous Sublingual Topical Tracheostomy Transdermal Urethral Ventimask Wound The dosage unit of the patient's current medication GMS Inches IU KVO (TKO) L/MIN LITERS LPM MCG MCG/KG/MIN MEQ MG MG/KG/MIN ML ML/HR Other Puffs The numeric dose or amount of the patient's current medication The medications the patient currently takes Attribute group used to define the current status of an element value and the date the status was confirmed The corresponding date date of birth The date/time the injury occurred, or the date/time the symptoms or problem started The Patients diastolic blood pressure The patient's ethnicity as defined by the OMB (US Office of Management and Budget) Hispanic or Latino Not Hispanic or Latino The Patients Gender Male Female Last name The medication given to the patient The procedure performed on the patient The protocol used by EMS personnel to direct the clinical care of the patient Abdominal Pain Airway Airway-Failed Airway-RSI Allergic Reaction/Anaphylaxis Altered Mental Status Asystole Back Pain Behavorial Bites and Envenomations Bradycardia Burns Cardiac Arrest Cardiac Chest Pain Childbirth/Labor Cold Exposure Dental Problems Device Malfunction Diarrhea Drowning/Near Drowning Diving Emergencies Electrical Injuries Epistaxis Exposure-Airway Irritants Exposure-Biological/Infectious Exposure-Blistering Agents Exposure-Cyanide Exposure-Nerve Agents Exposure-Radiologic Agents Exposure-Riot Control Agents Extremity Trauma Eye Trauma Fever Gynecologic Emergencies Head Trauma Hyperglycemia Hypertenshion Hyperthermia Hypoglycemia Hypotension/Shock (Non-Trauma) Hypothermia IV Access Trauma-Multisystem Newly Born Obstetrical Emergencies Over Dose/Toxic Ingestion Pain Control Post Resuscitation Pulmonary Edema Pulseless Electrical Activity (PEA) Respiratory Distress Seizure Spinal Immobilzation Supraventricular Tachycardia Stroke/TIA Syncope Trauma-Arrest Trauma-Amputation Universal Patient Care Ventricular Fibrillation Ventricular Ectopy Ventricular Tachycardia Vomiting The patient's race as defined by the OMB (US Office of Management and Budget) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other Race All of the potential levels of certification/licensure for EMS personnel recognized by the state. EMT-Basic EMT-Intermediate EMT-Paramedic Nurse Physician First Responder ZIP code Geographic zone representing the location The simple type to define Descriptive Text can have alpha numeric spaces commas or periods Endotracheal Tube location verification on the arrival at the Destination (if applicable) Auscultation of Bilateral Breath Sounds Colormetric CO2 Detector Confirmation Digital CO2 Confirmation Esophageal Bulb Aspiration confirmation Negative Auscultation of the Epigastrium Visualization of the Chest Rising with ventilation Visualization of Tube Passing Through the Cords Waveform CO2 Confirmation The patient's medical record number at the patient's receiving facility The code of the destination the patient was delivered or transferred to The destination the patient was delivered or transferred to The Patients end-tidal or other CO2 level The Units of Carbon Dioxide, end-tidal Carbon Dioxide, invasive pressure monitor 1, or invasive pressure monitor 2 as measured from the device transducers (if appropriate for the event) The Invasive Pressure Mean as calculated either through the invasive pressure monitor 1 or the invasive pressure monitor 2 (if appropriate for the event) The manufacturer of the medical device. The local number or configurable ID/Name of the medical device. The unique manufacturer's serial number associated with a medical device. The patients drivers license number The duration of the chief complaint The duration of the secondary complaint The interpretation of the rhythm by the device (if appropriate for the event) The lead or source which the medical device used to obtain the rhythm (if appropriate for the event) I II III AVR AVL AVF V1 V2 V3 V4 V5 V6 Paddle The Patients heart rate as recorded by an electric monitoring device (ECG, pulse oximetry, etc.) An Email Address The EMD card number reported by dispatch, consisting of the card number, dispatch level, and dispatch mode Indication of whether EMD was performed for this EMS event. Yes, With Pre-Arrival Instructions Yes, Without Pre-Arrival Instructions No The Vendor or company associated with the EMD card set and algorithms The known disposition of the patient from the Emergency Department (ED) Admitted to Hospital Floor Admitted to Hospital ICU Death Not Applicable (Not Transported to ED) Released Transferred Personnel's Employment Status for this Agency. Full Time Paid Employee Full Time Unpaid Employee Part Time Paid and Part Time Unpaide Employee Part Time Paid Employee Part Time Unpaid Employee No Longer Employed by Service Indicate if the EMS Agency conforms to Daylight Savings Time. No Yes The formal name of the agency The state-assigned provider number of the responding agency The time zone for the EMS Agency. GMT-11:00 Midway Island, Somoa Hawaii Alaska Pacific Time Mountain Time Central Time Eastern Time Atlantic Time The number of EMS patient encounters which are billable based on the last calendar year. The number of EMS dispatches per based on last last calendar year. The number of EMS patient contacts per year based on last calendar year The number of EMS transports per year based on last calendar year. The 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. The unique physical vehicle number of the responding unit The internal EMS response number which is unique for each EMS unit's (vehicles) response to an incident within an agency. The patient's known allergies to food or environmental agents. Insect Sting Food Allergy Latex Chemical Other None The patients body weight in kilograms either measured or estimated The date/time differential between the initial responder and the EMS unit arriving on the scene, if applicable. Greater Than 15 minutes 5 - 15 Minutes Less Than 5 Minutes After EMS The length of time the patient was down (estimated) before the responding unit arrived at the patient Greater Than 20 Minutes 15-20 Minutes 10-15 Minutes 8-10 Minutes 6-8 Minutes 4-6 Minutes 2-4 Minutes 0-2 Minutes The patient's ethnicity as defined by the OMB (US Office of Management and Budget) Hispanic or Latino Not Hispanic or Latino The assessment of the patients left lower extremities on examination Normal Not Done Abnormal Pulse Abnormal Sensation Edema Tenderness Weakness The assessment of the patients left upper extremities on examination Normal Not Done Abnormal Pulse Abnormal Sensation Edema Tenderness Weakness The assessment of the patients right lower extremities on examination Normal Not Done Abnormal Pulse Abnormal Sensation Edema Tenderness Weakness The assessment of the patients right upper extremities on examination Normal Not Done Abnormal Pulse Abnormal Sensation Edema Tenderness Weakness The assessment of the patients left eye on examination Not Done 2-mm 3-mm 4-mm 5-mm 6-mm 7-mm Blind Reactive Non-Reactive The assessment of the patients right eye on examination Not Done 2-mm 3-mm 4-mm 5-mm 6-mm 7-mm Blind Reactive Non-Reactive The Hospital or facility name The state identifying number for the hospital or facility The type of facility associated with the Other Destination. (D04_8). Home Hospital Medical Office/Clinic Morgue Nursing Home Other Other EMS Responder (air) Other EMS Responder (ground) Police/Jail The unique number associated with the fire incident report which can be used for linkage at a later date. Documentation of what the first monitored rhythm which was noted Asystole Bradycardia Normal Sinus Rhythm Other PEA Unknown AED Non-Shockable Rhythm Unknown AED Shockable Rhythm Ventricular Fibrillation Ventricular Tachycardia First name The Patients Glasgow Coma Score: Eye The Patients Glasgow Coma Score: Motor Documentation of the factors which make the GCS score more meaningful Initial GCS has legitimate values without interventions such as intubation and sedation Patient Chemically Sedated Patient Intubated Patient Intubated and Chemically Paralyzed The Patients Glasgow Coma Score: Verbal The Patients Gender Male Female Attribute group used to define the GPS Location of the data element. The assessment of the patients GU area on examination Normal Not Done Crowning Genital Injury Tenderness Unstable Theassessment of the patients face on examination Normal Not Done Asymmetric Smile or Droop Drainage Mass/Lesion Swelling The assessment of the patients heart on examination Normal Not Done Decreased Sounds Murmur The distance in feet the patient fell, measured from the lowest point of the patient to the ground Indication of how the patient was dispositioned from the hospital, if admitted. Death Discharged Transfer to Hospital Transfer to Nursing Home Transfer to Other Transfer to Rehabilitation Facility The method the patient was moved to the ambulance from the scene Assisted/Walk Carry Stairchair Stretcher Other The method the patient was moved from the ambulance to the destination Assisted/Walk Carry Stairchair Stretcher Other The ICD-9 Code assigned by CMS for the condition code documented in E07_35_ This is based on the CMS EMS negotiated rule-making process. The date of the associated immunization type (E138). The type of Immunization Anthrax DPT (Diphtheria, Tetanus, Pertussis) Hemophilus Influenza B Hepatitis A Hepatitis B Influenza (Flu) MMR (Measles, Mumps, Rubella) Polio = 8, Pneumococcal (pneumonia) Small Pox Tetanus Varicella The state or regulatory number (code) associated with the facility if the Incident is a Healthcare Facility. The kind of location where the incident happened Home/Residence Farm Mine or Quarry Industrial Place and Premises Place of Recreation or Sport Street or Highway Public Building (schools, gov. offices) Trade or service (business, bars, restaurants, etc) Health Care Facility (clinic, hospital, nursing home) Residential Institution (Nursing Home, jail/prison) Lake, River, Ocean Other Location The incident number assigned by the 911 Dispatch System Type of disposition treatment and/or transport of the patient. Cancelled Dead at Scene No Patient Found No Treatment Required Patient Refused Care Treated and Released Treated, Transferred Care Treated, Transported by EMS Treated, Transported by Law Enforcement Treated, Transported by Private Vehicle The billing priority or order for the insurance company. Primary Secondary Other The ID number of the patient's insurance company The Insurance company name The ID number or name of the patient's insurance group The ID number of the patient's insurance policy The intent of the individual inflicting te injury Intentional, Other (Assaulted) Intentional, Self Unintentional Last name Last name The unique number associated with the law enforcement or crash report which can be used for linkage at a later date. The patients level of responsiveness Alert Verbal Painful Unresponsive Last name The mechanism of the event which caused the injury Blunt Burn Other Penetrating The type of event documented by the medical device. 12-Lead ECG Analysis (Button Pressed) CO2 Date Transmitted Defibrillation ECG-Monitor Heart Rate Invasive Pressure 1 Invasive Pressure 2 No Shock Advised Non-Invasive BP Pacing Electrical Capture Pacing Started Pacing Stopped Patient Connected Power On Pulse Oximetry Pulse Rate Respiratory Rate Shock Advised Sync Off Sync On Type of person medical history obtained from Bystander/Other Family Health Care Personnel None Patient The patient's pre-existing medical and surgery history of the patient The route medication was administered to the patient Edotracheal tube Gastrostomy tube Inhalation Intramuscular Intraosseous Intranasal Intraocular Intravenous Nasal Nasal prongs Nasogastric Ophthalmic Oral Other/miscellaneous Otic Re-breather mask Rectal Subutaneous Sublingual Topical Tracheostomy Transdermal Urethral Ventimask Wound The patient's medication allergies The type of treatment authorization obtained On-Line On-Scene Protocol (Standing Order) Written Orders (Patient Specific) Any compliucation (abnormal effect on the patient) associated with the administration of the medication to the patient by EMS None Altered Mental Status Apnea Bleeding Bradycardia Diarrhea Extravasion Hypertension Hyperthermia Hypotension Hypoxia Injury Itching/Urticaria Nausea Other Respiratory Distress Tachycardia Vomiting The dose or amount of the medication given to the patient The unit of medication dosage given to patient GMS Inches IU KVO (TKO) L/MIN LITERS LPM MCG MCG/KG/MIN MEQ MG MG/KG/MIN ML ML/HR Other Puffs The medication given to the patient The assessment of the patients mental status Normal Not Done Combative Confused Hallucinations Oriented-Person Oriented-Place Oriented-Time Unresponsive Indication of method of blood pressure procedure Aterial Line Automated Cuff Manual Cuff Palpated Cuff Venous Line Middle name The specific manufacturer's model number associated with medical device. The Name assigned to the element The National Provider Identifier associated with National Provider System (NPS) and used in all standard HIPPA transactions such as electronic claim filing. The assessement of the patients head and neck area on examination Normal Not Done JVD Strider SubQ Air Tracheal Dev The assessment of the patients neurolgical status on examination Normal Not Done Abnormal Gait Facial Droop Seizures Speech Normal Speech Slurring Tremors Weakness-Left Sided Weakness-Right Sided The level of cerebral performance of the patient at the time of discharge from the Hospital Cerebral Performance Categories: 1. Good Cerebral Performance. Conscious, Alert, able to work and lead a normal life. 2. Moderate Cerebral Disability. Conscious. Able to function independently (dress, travel, prepare food). May have Hemiplegia, Seizures, or permanent memory or mental changes) 3. Severe Cerebral Disability. Conscious. Dependent on others for daily support. Functions only in an institution or at home with exceptional family effort. 4. Coma, Vegetative state. CPC 1 or 2 CPC 3 or 4 The NHTSA injury matrix used to describe the type of injury Amputation Bleeding Controlled Bleeding Uncontrolled Burn Crush Dislocation Fracture Gunshot Laceration Pain without swelling/bruising Puncture/stab Soft Tissue Swelling/bruising The corresponding date The Values used to describe Null fieldsd Not Available Not Known Not Reporting Not Recorded Not Applicable Indicator of how many total patients were at the scene None Single Mulitiple The Vendor or company associated with the EMD card set and algorithms The number of attempts taken to complete a procedure or intervention reguardless of success The mileage (odometer reading) of the vehicle rounded to the nearest mile The organizational structure from which EMS services are delivered (fire, hospital, county, etc.) Community, Non-Profit Fire Department Governmental, Non-Fire Hospital Private, Non_Hospital Tribal The primary organizational status of the agency. The definition of Volunteer or Non-Volunteer is based on state or local terms. Mixed Non-Volunteer Volunteer All other EMS or First Responder Agencies, which are in the service area or are available for mutual aname. Other symptoms identified by the patient or observed by EMS personnel Bleeding Breathing Problem Change in responsiveness Choking Death Device/Equipment Problem Diarrhea Drainage/Discharge Fever Malaise Mass/Lesion Mental/Psych Nausea/Vomiting None Pain Palpitations Rash/Itching Swelling Transport Only Weakness Wound Other EMS agencies that were at the scene, if any Other services that were at the scene, if any EMS Mutual Aid Fire Hazmat Law Other Health Care Provider Other Rescue Utilities The other service type(s) which are provided by the agency. 911 Response (Scene) with Transport Capability 911 Response (Scene) without Transport Capability Air Medical Hazmat Medical Transport (Convalescent) Paramedic Intercept Rescue Speciality Care Transport What was the outcome or result of the care performed prior to the arrival of the unit. Improved Unchanged Worse The rate the device was calibrated to pace during the event, if appropriate. The Patients Indication of pain from a scale of 1 - 10 The 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. The unique number associated with a patient ID band agency. This is used by a few states as a universal linkage between healthcare data agency's. The occupation of the patient Management Occupations Business and Financial Operations Occupations Computer and Mathematical Occupations Architecture and Engineering Occupations Life, Physical, and Social Science Occupations Community and Social Services Occupations Legal Occupations Education, Training, and Library Occupations Arts, Design, Entertainment, Sports, and Media Occupations Healthcare Practitioners and Technical Occupations Healthcare Support Occupations Protective Service Occupations Food Preparation and Serving Related Occupations Building and Grounds Cleaning and Maintenance Occupations Personal Care and Service Occupations Sales and Related Occupations Office and Administrative Support Occupations Farming, Fishing and Forestry Occupations Construction and Extraction Occupations Installation, Maintenance, and Repair Occupations Production Occupations Transportation and Material Moving Occupations Military Specific Occupations The occupational industry of the patient's work Construction Finance, Insurance, and Real Estate Government Manufacturing Mining Retail Trade Services Transportation and Public Utilities Wholesale Trade The Trauma Score for patients 12 and under The personal protective equipment which was used by EMS personnel during this EMS patient contact. Eye Protection Gloves Level A Suit Level B Suit Level C Suit Mask Other The EMS personnel who was/were exposed to unprotected contact with blood or body fluids This EMS Crew Non-EMS individual Other EMS Personnel Local agency name number for personnel. The position of the patient during transport from the scene Car Seat Fowlers Lateral Prone Semi-Fowlers Sitting Supine Other The position of the patient in seat of the vehicle at the time of crash Driver Left (non-driver) Middle Other Right An indication if the patient may meet the entry criteria for a injury or illness specific registry Burn Cardiac/MI CVA/Stroke Drowning Spinal Cord Injury Trauma Traumatic Brain Injury Other The primary method of payment or type of insurance associated with this EMS encounter Insurance Medicaid Medicare Not Billed (for any reason) Other Goverment Self Pay Workers Compensation The primary roll of the EMS service which was requested for this specific EMS incident. Non-Transport Rescue Supervisor Transport The primary sign and symptom present in the patient or observed by EMS personnel Bleeding Breathing Problem Change in responsiveness Choking Death Device/Equipment Problem Diarrhea Drainage/Discharge Fever Malaise Mass/Lesion Mental/Psych Nausea/Vomiting None Pain Palpitations Rash/Itching Swelling Transport Only Weakness Wound The primary service type provided by the agency. 911 Response (Scene) with Transport Capability 911 Response (Scene) without Transport Capability Air Medical Hazmat Medical Transport (Convalescent) Paramedic Intercept Rescue Speciality Care Transport Any care which was provided to the patient prior to the arrival of this unit. The type of individual who performed the care prior to the arrival of this unit. EMS Provider Law Enforcement Lay Person Other Healthcare Provider Patient The procedure performed on the patient The type of treatment authorization obtained On-Line On-Scene Protocol (Standing Order) Written Orders (Patient Specific) The last id of the authorizing physician ordering the procedure if the order was provided by any manner other than protocol (standing order) Any complication (abnormal effect on the patient) associated with the performance of the procedure on the patient None Altered Mental Status Apnea Bleeding Bradycardia Diarrhea Esophageal Intubation-immediately Esophageal Intubation-other Extravasion Hypertension Hyperthermia Hypotension Hypoxia Injury Itching/Urticaria Nausea Other Respiratory Distress Tachycardia Vomiting 12 Lead ECG-Obtain 12 Lead ECG-Transmitted Activation-Advanced Hazmat Specialty Service/Response Team Activation-Fire Rehabilitation Specialty Service/Response Team Activation-Other Specialty Service/Response Team Activation-Rescue Specialty Service/Response Team Activation-Social Services Notification/Referral Activation-Tactical or SWAT Specialty Service/Response Team Airway-Bagged (via tube) Airway-Bagged (via BVMask) Airway-BiPAP Airway-Change Tracheostomy Tube "Airway-Cleared, Opened, or Heimlich" Airway-Combitube Blind Insertion Airway Device Airway-CPAP Airway-Direct Laryngoscopy Airway-EOA/EGTA Airway-Extubation Airway-Foreign Body Removal Airway-Impedence Threshold Device Airway-Intubation Confirm Colorimetric ETCO2 Airway-Intubation Confirm Esophageal Bulb Airway-Intubation of Existing Tracheostomy Stoma Airway-King LT Blind Insertion Airway Device Airway-Laryngeal Mask Blind Insertion Airway Device Airway-Nasal Airway-Nasotracheal Intubation Airway-Nebulizer Treatment Airway-Needle Cricothyrotomy Airway-Oral Airway-Orotracheal Intubation Airway-PEEP Airway-Rapid Sequence Induction Airway-Respirator Operation (BLS) Airway-Suctioning Airway-Surgical Cricothyrotomy Airway-Ventilator Operation Airway-Ventilator with PEEP Airway-Video Laryngoscopy Arterial Access-Blood Draw Arterial Line Maintenance Assessment-Adult Assessment-Pediatric Blood Glucose Analysis Capnography (CO2 Measurement) Cardiac Monitor Cardiac Pacing-External Cardiac Pacing-Transvenous Cardioversion Chest Decompression Chest Tube Placement Childbirth CNS Catheter-Epidural Maintenance CNS Catheter-Intraventricular Maintenance Contact Medical Control CPR by Other External Automated Device CPR-AutoPulse Device CPR-Mechanical Thumper Type Device CPR-Precordial Thump Only CPR-Start Compressions and Ventilations CPR-Start Compressions only without Ventilation CPR-Start Rescue Breathing without Compressions CPR-Stop Decontamination Defibrillation-Automated (AED) Defibrillation-Manual Defibrillation-Placement for Monitoring/Analysis Escharotomy Extrication Gastric Tube Insertion-Inserted Nasally Gastric Tube Insertion-Inserted Orally Injections-SQ/IM Intra-Aortic Balloon Pump Maintenance Joint Reduction/Relocation Left Ventricular Assist Device Maintenance MAST Orthostatic Blood Pressure Measurement Pain Measurement "Patient Cooling (Cold Pack, etc.)" Patient Cooling-Post Resuscitation Patient Loaded Patient Loaded-Helicopter Hot-Load "Patient Monitoring of Pre-existing Devices, Equipment, or Ongoing Medications" Patient Off-Loaded Patient Off-Loaded Helicopter Hot Off-Load "Patient Warming (Hot Pack, etc.)" Pericardiocentesis Pulse Oximetry Rescue Restraints-Pharmacological Restraints-Physical Specialty Center Activation-Adult Trauma Specialty Center Activation-Pediatric Trauma Specialty Center Activation-Cardiac Arrest Specialty Center Activation-STEMI Specialty Center Activation-Stroke Spinal Immobilization Splinting-Basic Splinting-Traction Temperature Measurement Thrombolytic Screen Urinary Catheterization Vagal Maneuver-Carotid Massage Vagal Maneuver-Valsalva or Other Vagal Maneuver (Not Carotid Massage) Venous Access-Blood Draw Venous Access-Central Line Maintenance Venous Access-Discontinue Venous Access-Existing Catheter Venous Access-External Jugular Line Venous Access-Extremity Venous Access-Femoral Line Venous Access-Internal Jugular Line Venous Access-Intraosseous Adult Venous Access-Intraosseous Pediatric Venous Access-Subclavian Line Venous Access-Swan Ganz Maintenance Venous Access-Umbilical Vein Cannulation Wound Care-General Wound Care-Hemostatic Agent Wound Care-Irrigation Wound Care-Taser Barb Removal Wound Care-Tourniquet The protocol used by EMS personnel to direct the clinical care of the patient The 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). 789.00- Abdominal pain / problems 519.80- Airway obstruction 995.30- Allergic reaction 780.09- Altered level of consciousness 312.90- Behavioral / psychiatric disorder 427.50- Cardiac arrest 427.90- Cardiac rhythm disturbance 786.50- Chest pain / discomfort 250.90- Diabetic symptoms (hypoglycemia) 994.80- Electrocution 780.60- Hyperthermia 780.90- Hypothermia 785.59- Hypovolemia / shock 987.90- Inhalation injury (toxic gas) 798.99- Obvious death 977.90- Poisoning / drug ingestion 659.90- Pregnancy / OB delivery 786.09- Respiratory distress 799.10- Respiratory arrest 780.30- Seizure 959.90- Sexual assault / rape 987.90- Smoke inhalation 989.50- Stings / venomous bites 436.00- Stroke / CVA 780.20- Syncope / fainting 959.90- Traumatic injury 623.80- Vaginal hemorrhage The EMS personnel's impression of the patient's secondary problem or most significant condition which led to the management given to the patient (treatments, medications, or procedures). 789.00- Abdominal pain / problems 519.80- Airway obstruction 995.30- Allergic reaction 780.09- Altered level of consciousness 312.90- Behavioral / psychiatric disorder 427.50- Cardiac arrest 427.90- Cardiac rhythm disturbance 786.50- Chest pain / discomfort 250.90- Diabetic symptoms (hypoglycemia) 994.80- Electrocution 780.60- Hyperthermia 780.90- Hypothermia 785.59- Hypovolemia / shock 987.90- Inhalation injury (toxic gas) 798.99- Obvious death 977.90- Poisoning / drug ingestion 659.90- Pregnancy / OB delivery 786.09- Respiratory distress 799.10- Respiratory arrest 780.30- Seizure 959.90- Sexual assault / rape 987.90- Smoke inhalation 989.50- Stings / venomous bites 436.00- Stroke / CVA 780.20- Syncope / fainting 959.90- Traumatic injury 623.80- Vaginal hemorrhage The Patients oxygen saturation The Patients pulse rate, palpated or auscultated, expressed as a number per minute The clinical rhythm of the patients pulse (regular, irregular, etc.) Regular Irregular The patient's race as defined by the OMB (US Office of Management and Budget) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other Race The reason that CPR or the resuscitation efforts were discontinued. DNR Medical Control Order Obvious Signs of Death Protocol/Policy Requirements Completed Return of Spontaneous Circulation (pulse or BP noted) The reason the unit chose to deliver or transfer the patient to the destination Closest Facility (none below) Diversion Family Choice Insurance Status Law Enforcement Choice On-Line Medical Direction Other Patient Choice Patient's Physicians Choice Protocol Specialty Resource Center The relationship of the patient to the primary insured person Self Spouse Son/Daughter Other A customizable field to be used by local agencies for additional documentation or research. A customizable field to be used by local agencies for additional documentation or research. The patients respiratory effort Normal Labored Fatigued Absent Not Assessed The Patients respiratory rate expressed as a number per minute Indication whether or not lights and/or sirens were used on the vehicle on the way to the scene Initial Lights and Sirens, Downgraded to No Lights or Sirens Initial No Lights or Sirens, Upgraded to Lights and Sirens Lights and Sirens No Lights or Sirens The patients response to the medication Improved Unchanged Worse The patients response to the procedure Improved Unchanged Worse The urgency in which the EMS agency began to mobilize resources. Immediate Non-Immediate Indication of an attempt to resuscitate the patient who is in cardiac arrest (attempted, not attempted due to DNR, etc.) Attemted Defibrillation Attempted Ventilation Initiated Chest Compressions Not Attempted-Considered Futile Not Attempted-DNR Orders Not Attempted-Signs of Circulation Indication whether or not there was any return of spontaneous circulation Yes, Prior to ED Arrival Only Yes, Prior to ED Arrival and at the ED No The patient's revised trauma score The narrative of the run report The Patients systolic blood pressure The seat row location of the vehicle at the time of the crash with the front seat numbered as 1 The narrative of the patients secondary complaint The medical record number of the medical facility who is transferring care to EMS The size of the equipment used in the procedure on the patient The assessment of the patients skin on examination Normal Not Done Clammy Cold Cyanotic Jaundiced Lividity Mottled Pale Warm The patient's social security number The Name of the Vendor, Software Manufacturer or Software Developer The 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. The 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. The patient's home state, territory, or province, or District of Columbia, where the patient resides All of the potential levels of certification/licensure for EMS personnel recognized by the state. EMT-Basic EMT-Intermediate EMT-Paramedic Nurse Physician First Responder The state certification/licensure name number assigned to the crew member. The Name of the station The Identifier for the station The year the information pertains to The Status either active or inactive Active Inactive The patient's home mailing or street address The patients Los Angeles or Cincinnati Stroke Scale Results Cincinnati Stroke Scale Negative Cincinnati Stroke Scale Non-conclusive Cincinnati Stroke Scale Positive LA Stroke Scale Negative LA Stroke Scale Non-conclusive LA Stroke Scale Positive The Location of the IV site (if applicable) on the patient Antecubital-Left Antecubital-Right External Jugular-Left External Jugular-Right Femoral-Left IV Femoral-Left Distal IO Femoral-Right IV Femoral-Right IO Forearm-Left Forearm-Right Hand-Left Hand-Right Lower Extremity-Left Lower Extremity-Right Other Scalp Sternal IO Tibia IO-Left Tibia IO-Right Umbilical Suspicion of the listed multi-casualty or domestic terrorism causes. Biologic Agent Building Failure Chemical Agent Explosive Device Fire Hostage Event Mass Gathering Nuclear Agent Radioactive Device Secondary Destructive Device Shooting/Sniper Vehicular Weather The patients home or primary telephone number Documentation of the factors which make the GCS score more meaningful Axillary Oral Rectal Tympanic Urinary Catheter The results of the patients Thrombolytic Screen for potential Thrombolytic use Definite Contraindications to Thrombolytic use No Contraindications to Thrombolytic Use Possible Contraindications to Thrombolytic Use The time units of the duration of the patients chief complaint Seconds Minutes Hours Days Weeks Months Years The time units of the duration of the patients secondary complaint Seconds Minutes Hours Days Weeks Months Years The Patients total Glasgow Coma Score The number of times the patient was defibrillated, if the patient was defibrillated during the patient encounter. The personnel's total length of EMS service at any level. The total population in the agency's service area based if possible on year 2000 census data. The total square miles in the agency's service area. Indication whether or not lights and/or sirens were used on the vehicle while leaving scene Initial Lights and Sirens, Downgraded to No Lights or Sirens Initial No Lights or Sirens, Upgraded to Lights and Sirens Lights and Sirens No Lights or Sirens The unique number associated with the local or state trauma registry which can be used for linkage at a later date. Endotracheal Tube placement verification at the time the airway procedure was done Auscultation of Bilateral Breath Sounds Colormetric CO2 Detector Confirmation Digital CO2 Confirmation Esophageal Bulb Aspiration confirmation Negative Auscultation of the Epigastrium Visualization of the Chest Rising with ventilation Visualization of Tube Passing Through the Cords Waveform CO2 Confirmation The type of destination the patient was delivered or transferred to Home Hospital Medical Office/Clinic Morgue Nursing Home Other Other EMS Responder (air) Other EMS Responder (ground) Police/Jail The dispatch delays, if any, associated with the dispatch of the EMS unit to the patient encounter Caller (Uncooperative) High Call Volume Language Barrier Location (Inability to Obtain) No Units Available None Other Scene Safety (Not Secure for EMS) Technical Failure (Computer, Phone etc.) The response delays, if any, of the unit associated with the patient encounter Crowd Directions Distance Diversion HazMat None Other Safety Staff Delay Traffic Vehicle Crash Vehicle Failure Weather The scene delays, if any, of the unit associated with the patient encounter Crowd Directions Distance Diversion Extrication greater than 20 min. HazMat Language Barrier None Other Safety Staff Delay Traffic Vehicle Crash Vehicle Failure Weather The type of service or category of service requested of the EMS service responding for this specific EMS incident. 911 Response (Scene) Intercept InterFacility Transfer Medical Transport Mutual Aid Standby The energy form used by the device for the defibrillation (if appropriate for the event) Biphasic Monophasic The type of exposure or unprotected contact with blood or body fluids Contact to Broken Skin Contact to Intact Skin Contact with Eye Contact with Mucosal Surface Inhalation Exposure Needle Stick with Fluid Injection Needle Stick without Fluid Injection Other Physical injury Death None The transport delays, if any, of the unit associated with the patient encounter Crowd Directions Distance Diversion HazMat None Other Safety Staff Delay Traffic Vehicle Crash Vehicle Failure Weather The turn-around delays, if any, associated with the EMS unit associated with the patient encounter Clean-up Decontamination Documentation ED Overcrowding Equipment Failure Equipment Replenishment None Other Staff Delay Vehicle Failure Safety equipment in use by the patient at the time of the injury Child Restraint Eye Protection Helmet Worn Lap Belt None Other Personal Floatation Device Protective Clothing Protective Non-Clothing Gear Shoulder Belt The station (or hospital) representing the geographic location of the vehicle at the time of dispatch The Vendor or company associated with the EMD card set and algorithms The Original cost of a vehicle The Vendor or company associated with the EMD card set and algorithms Vehicle type of unit (ambulance, fire, truck, etc.) Ambulance ATV Bicycle Boat Fire Truck Fixed Wing Motorcycle Other Private Vehicle Quick Response Vechicle (Non-Transport Vehicle other than Fire Truck Rescue Rotor Craft The year the information pertains to The kind of risk factor predictors present at the incident Dash Deformity DOA Same Vehicle Ejection Fire Rollover/Roof Deformity Side Post Deformity Space Intrusion > 1 foot Steering Wheel Deformity Windshield Spider/Star The graphic waveform file in a PDF or JPG format. The type of waveform file stored in Waveform Graphic (E21.4) JPG PDF An URL for a website The year the information pertains to Yes No value data type Yes No ZIP code Geographic zone representing the location