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The National Emergency Medical Services Information System (NEMSIS) is a federally funded program designed to standardize Emergency Medical Services (EMS) patient care reporting and facilitate state and national data repositories for the assessment and improvement of EMS systems of care. This manuscript characterizes the 2020 submissions to the National EMS Database, detailing the strengths and limitations associated with use of these data for public health surveillance, improving prehospital patient care, critical resource allocation, clinician safety, system quality assurance and research purposes.Using the 2020 NEMSIS Public-Release Research Dataset (NEMSIS dataset), we evaluated the dataset completeness (i.e., presence of missing/null values), dataset content and assessed data generalizability. The analysis focused on 9-1-1 EMS activations resulting in the treatment and transport of a patient, except for out-of-hospital cardiac arrests for which all patients were included regardless of transport status.In 2020, 43,488,767 EMS activations were reported to the National EMS Database by 12,319 agencies serving 50 states and territories. Of the 19,533,036 9-1-1 EMS activations reportedly treating and transporting a patient, the majority were attended by "non-volunteer" clinicians (77%) working in a fire-based EMS agency (35%) certified to offer Advanced Life Support (ALS) Paramedic service (80%) and located in an urban area (82%). 9-1-1 call centers most often dispatched EMS for "sick person" (20%), while EMS clinicians most likely reported asthenia (7%) as the patient's primary symptom as well as the clinician's primary impression (6%), and documented "fall on same level, slip, or trip" as the most common cause of injury (37%). The NEMSIS dataset demonstrates some "missingness" and element inconsistencies, but methods may be employed to mitigate these data limitations.The National EMS Database is a free and publicly available resource for evaluating EMS system utilization, response, and prehospital patient care. Understanding the characteristics of the underlying dataset and known data limitations will help ensure proper analysis and reporting of research and quality metrics based on nationally standardized NEMSIS data.

Background: Research networks need access to EMS data to conduct pilot studies and determine feasibility of prospective studies. Combining data across EMS agencies is complicated and costly. Leveraging the National EMS Information System (NEMSIS) to extract select agencies’ data may be an efficient and cost-effective method of providing network-level data. Objective: Describe the process of creating a Pediatric Emergency Care Applied Research Network (PECARN) specific NEMSIS data set and determine if these data were nationally representative. Methods: We established data use agreements (DUAs) with EMS agencies participating in PECARN to allow for agency identification through NEMSIS. Using 2019 NEMSIS version 3.4.0 data for EMS events with patients 18 years old and younger, we compared PECARN NEMSIS data to national NEMSIS data. Analyzed variables were selected for their ability to characterize events. No statistical analyses were utilized due to the large sample, instead, differences of ±5% were deemed clinically meaningful. Results: DUAs were established for 19 EMS agencies, creating a PECARN data set with 305,188 EMS activations of which 17,478 (5.7%) were pediatric. Of the pediatric activations, 17,140 (98.1%) were initiated through 9-1-1 and 9,487 (55.4%) resulted in transport by the documenting agency. The national data included 36,288,405 EMS activations of which 2,152,849 (5.9%) were pediatric. Of the pediatric activations 1,704,141 (79.2%) were initiated through 9-1-1 and 1,055,504 (61.9%) were transported by the documenting agency. Age and gender distributions were similar between the two groups, but the PECARN-specific data under-represents Black and Latinx patients. Comparison of EMS provider primary impressions revealed that three of the five most common were similar with injury being the most prevalent for both data sets along with mental/behavioral health and seizure. Conclusion: We demonstrated that NEMSIS can be leveraged to create network specific data sets. PECARN’s EMS data were similar to the national data, though racial/ethnic minorities and some primary impressions may be under-represented. Additionally, more EMS activations in PECARN study areas originated through 9-1-1 but fewer were transported by the documenting agency. This is likely related to the type of participating agencies, their ALS response level, and the diversity of the communities they serve.

Child abuse and neglect (CAN) has an estimated annual incidence of 1.46% among those ≤3 years old. Prehospital providers (PHPs) report difficulties identifying CAN and the frequency in which PHPs document CAN during prehospital encounters of young children is not known.To report the percentage of CAN documentation by PHPs during encounters among children ≤3 years in a national dataset and describe the characteristics of this population.This is an analysis of concurrent cases in the 2017-18 National Emergency Medical Services Information System database. We identified children ≤3 years old with ICD-10-CM codes specific for CAN including codes for physical and sexual abuse as well as neglect. We examined patient demographics including race, gender, Emergency Medical Services (EMS) primary and secondary impression, associated symptoms, anatomic location of chief complaint, and cause of injury. Our primary outcome is the percentage of CAN reported as an EMS primary or secondary impression; secondary outcomes include proportion of children with each subtype of abuse, the description of patients by demographic information, anatomic location of injury, and associated symptoms.There were 498,555 for children ≤3 years old, of which 522 had an impression of CAN (0.10%). Within our cohort, 43% were1 year of age, 51% were male. The most common anatomic location of injury was general/global (29.7%), followed by head (23.5%) and extremity (14%). The most common symptoms reported by PHPs are those associated with injury including codes for injury, burn, fracture, cutaneous findings, hemorrhage, or pain (The percentage of PHP documentation of CAN among children ≤3 years of age is very low. Among those with an EMS primary impression of CAN, documentation is primarily associated with findings of injury whereas documentation of nonspecific symptoms such as vomiting and seizure is infrequent. These findings suggest that recognition of abuse primarily occurs in young patients with overt signs of trauma.

Background: Chest pain is a leading complaint in emergency settings. Timely emergency medical services (EMS) responses can reduce delays to treatment and improve clinical outcomes for acute myocard...

The purpose of the current study was to describe the injury patterns, EMS response and interventions to mass shooting (MS) and active shooter (AS) incidents.Retrospective analysis of 2014-2015 National Emergency Medical Services Information System (NEMSIS) data sets. Date, time, and location for MS incidents were obtained from the Gun Violence Archive and then correlated with NEMSIS data set records. AS incidents were identified through Federal Bureau of Investigation (FBI) data. A de-identified database was generated for final analysis.A total of 608 MS incidents were identified, of which 19 were also classified as AS incidents. NEMSIS patient care data was available for 652 EMS activations representing 226 unique MS incidents. Thirty-four EMS responses to 5 unique AS incidents were similarly identified: 76% of victims were male and 80% of victims were African American. Dispatch complaint did not suggest shooting (potentially dangerous scene environment) in 15.9% of records. The most commonly reported incident locations for MS were Street/Highway (38.2%) and Home/Residence (32.4%). Location of wounds included extremities (49%), chest (12%), and head/neck (13%). Tourniquet use was documented in 6 victims. 35.9% of victims were transported to the closest facility.MS and AS incidents are prevalent in the United States. Despite the fact that extremity wounds were common, documented EMS tourniquet use was uncommon. While MS events are high risk for responders, dispatch information was lacking in almost 15% of records. Responding EMS agencies were diverse, emphasizing the need to ensure all EMS providers are prepared to respond to MS incidents.

The use of emergency medical services (EMS) for diabetes-related events is believed to be substantial but has not been quantified nationally despite the diverse acute complications associated with diabetes. We describe diabetes-related EMS activations in 2015 among people of all ages from 23 U.S. states.We used data from 23 states that reported ≥95% of their EMS activations to the U.S. National Emergency Medical Services Information System (NEMSIS) in 2015. A diabetes-related EMS activation was defined using coded EMS provider impressions of "diabetes symptoms" and coded complaints recorded by dispatch of "diabetic problem." We described activations by type of location, urbanicity, U.S. Census Division, season, and time of day; and patient-events by age category, race/ethnicity, disposition, and treatment with glucose. Crude and age-adjusted diabetes-related EMS patient-level event rates were calculated for adults ≥18 years of age with diagnosed diabetes using the Behavioral Risk Factor Surveillance System to estimate the population denominator.Of 10,324,031 relevant EMS records, 241,495 (2.3%) were diabetes-related activations, which involved over 235,000 hours of service. Most activations occurred in urban or suburban environ- ments (86.4%), in the home setting (73.5%), and were slightly more frequent in the summer months. Most patients (72.6%) were ≥45 years of age and over one-half (55.4%) were transported to the emergency department. The overall age-adjusted diabetes-related EMS event rate was 33.9 per 1,000 persons with diagnosed diabetes; rates were highest in patients 18-44 years of age, males, and non-Hispanic blacks and varied by U.S. Census Division.Diabetes results in a substantial burden on EMS resources. Collection of more detailed diabetes complication information in NEMSIS may help facilitate EMS resource planning and prevention strategies.

Historically, pain management in the prehospital setting, specifically pediatric pain management, has been inadequate despite many EMS (emergency medical services) transports related to traumatic injury with pain noted as a symptom. The National Emergency Services Information System (NEMSIS) database offers the largest national repository of prehospital data, and can be used to assess current patterns of EMS pain management across the country.To analyze prehospital management of pain using NEMSIS data, and to assess if variables such as patient age and/or race/ethnicity are associated with disparity in pain treatment.A retrospective descriptive study over a three-year period (2012-2014) of the NEMSIS database for patients evaluated for three potentially painful medical impressions (fracture, burn, penetrating injury) to assess the presence of documented pain as a symptom, and if patients received treatment with analgesic medications. Results were analyzed according to type of pain medication given, age categories, and race/ethnicity of the patients.Percentage of EMS transports documenting the three painful impressions that had pain documented as a symptom, received any of the six pain medications, and the disparity in documentation and treatment by age and race/ethnicity.There were 276,925 EMS records in the NEMSIS database that met inclusion criteria. Pain was listed as a primary or associated symptom for 29.5% of patients, and the youngest children (0-3 years) were least likely to have pain documented as a symptom (14.6%). Only 15.6% of all activations documented the receipt of prehospital pain medications. Children (15 years) received pain medication 14.8% [95% CI 14.33, 15.34] of the time versus adults (≥15 years) 15.6% [95% CI 15.48, 15.76, p = 0.004]. Morphine and fentanyl were the most commonly administered medications to all age groups. Black patients were less likely to receive pain medication than other racial groups.Documentation of pain as a symptom and pain treatment continue to be infrequent in the prehospital setting in all age groups, especially young children. There appears to be a racial disparity with Black patients less often treated with analgesics. The broad incorporation of national NEMSIS data suggests that these inadequacies are a widespread challenge deserving further attention.

Emergency medical services (EMS) must provide a wide range of care for patients in the out-of-hospital setting. Although previous work has detailed that EMS providers rarely perform certain procedures, (e.g., endotracheal intubation) there are limited data detailing the frequency of procedures across the breadth of EMS providers' scope of practice. We sought to characterize procedures performed by EMS in the United States. We conducted an analysis of the 2011 National Emergency Medical Services Information System (NEMSIS) research data set, encompassing EMS emergency response data from 40 states and two territories. From these data, we report the number and incidence of EMS procedures. We also characterize procedures performed. There were 14,371,941 submitted EMS responses, of which 7,680,559 had complete information on procedures performed on adults. Of these, 4,206,360 EMS responses had procedures performed totaling 11,407,396 procedures. The most common procedures performed were peripheral venous access (28.4%), cardiac monitoring (16.1%) pulse oximetry (13.5%), and blood glucose analysis (10.4%). Procedures were performed most often in patients with traumatic injury (20.0%) followed by chest pain/discomfort (14.0%). Critical procedures (cardioversion, defibrillation, endotracheal intubation, etc.) were infrequently performed (n = 277,785, 2.4%). These data highlight the frequency with which EMS providers perform procedures across the United States. This may help to guide future EMS training and education efforts by highlighting the relative frequency and infrequency of specific procedures.

The National Emergency Medical Services Information System (NEMSIS) is a federally funded project designed to standardize emergency medical services (EMS) patient care reporting and facilitate state and national data repositories for the assessment of EMS systems of care. The purpose of this assessment is to characterize the annual NEMSIS 2012 Public-Release Research Dataset, detailing the strengths and limitations associated with use of these data for EMS quality assurance and/or research purposes.Using descriptive statistics, we evaluated the dataset completeness (i.e., presence of missing/null values) and dataset content. To assess data generalizability, we compared age distributions to the 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS). Subanalyses were conducted for cardiac arrest- and trauma-related EMS activations to describe their characteristics, treatments, and dispositions. The analysis focuses primarily on 9-1-1 EMS activations resulting in the treatment and transport of a patient, excepting the analysis conducted for out-of-hospital cardiac arrests (OHCA), which includes scene deaths.In 2012, 19,831,189 EMS activations were reported to NEMSIS by 8,439 agencies located in 42 states and territories. Of the 10,733,925 9-1-1 EMS activations reportedly treating and transporting a patient, the majority were attended by a paid EMT-paramedic (82%) employed by a fire-based EMS agency (25%) working in an urban area (53%). 9-1-1 call centers most likely dispatched EMS for a "sick person" (14%), while providers most likely reported pain (26%) as the patient's primary symptom and "traumatic injury" (13%) as the likely cause. NEMSIS data adequately characterize specific patient populations and demonstrate significant similarity to independent distributions of EMS patients (i.e., NHAMCS), yet missing data and use of null values remain prevalent.The annual NEMSIS Public-Release Research Dataset is a valuable resource for evaluating the U.S. EMS activation population and can be used to conduct in-depth descriptions of the care of specific populations. However, the utility of the data are limited until the number of null values can be diminished and reporting becomes universal.

ObjectiveTo evaluate the ability of out-of-hospital physiologic measures to predict serious injury for field triage purposes among older adults and potentially reduce the undertriage of seriously injured elders to non-trauma hospitals.MethodsThis was a retrospective cohort study involving injured adults 55 years and older transported by 94 emergency medical services (EMS) agencies to 122 hospitals (trauma and non-trauma) in 7 regions of the western United States from January 1, 2006 to December 31, 2008. We evaluated initial out-of-hospital Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), respiratory rate, heart rate, shock index (SBP ÷ heart rate), out-of-hospital procedures, mechanism of injury, and patient demographics. The primary outcome was "serious injury," defined as Injury Severity Score (ISS) ≥ 16, as a measure of trauma center need. We used multivariable regression models, fractional polynomials and binary recursive partitioning to evaluate appropriate physiologic cut-points and the value of different physiologic triage criteria.ResultsA total of 44,890 injured older adults were evaluated and transported by EMS, of whom 2,328 (5.2%) had ISS ≥ 16. Nonlinear associations existed between all physiologic measures and ISS ≥ 16 (unadjusted and adjusted p ≤ 0.001 for all,), except for heart rate (adjusted p = 0.48). Revised physiologic triage criteria included GCS score ≤ 14; respiratory rate < 10 or > 24 breaths per minute or assisted ventilation; and SBP < 110 or > 200 mmHg. Compared to current triage practices, the revised criteria would increase triage sensitivity from 78.6 to 86.3% (difference 7.7%, 95% CI 6.1-9.6%), reduce specificity from 75.5 to 60.7% (difference 14.8%, 95% CI 14.3-15.3%), and increase the proportion of patients without serious injuries transported to major trauma centers by 60%.ConclusionsExisting out-of-hospital physiologic triage criteria could be revised to better identify seriously injured older adults at the expense of increasing overtriage to major trauma centers.

Objective. Planning for time-sensitive injury may allow emergency medical services (EMS) systems to more accurately triage patients meeting accepted criteria to facilities most capable of providing life-saving treatment. In 2010, North Carolina (NC) implemented statewide Trauma Triage and Destination Plans (TTDPs) in all 100 of North Carolina's county-defined EMS systems. Each system was responsible for identifying the specific destination hospitals with appropriate resources to treat trauma patients. We sought to characterize the accuracy of their hospital designations. Methods. In this cross-sectional study, we collected TTDPs for each county-defined EMS system, including their assigned hospital capabilities (i.e., trauma center or community hospital). We conducted a survey with each EMS system to determine how their TTDP was constructed and maintained, as well as with each TTDP-designated hospital to verify their capabilities. We determined the accuracy of the EMS assigned hospital designations by comparing them to the hospital's reported capabilities. Results. The 100 NC EMS systems provided 380 designations for 112 hospitals. TTDPs were created by EMS administrators and medical directors, with only 55% of EMS systems engaging a hospital representative in the plan creation. Compared to the actual hospital capabilities, 97% of the EMS TTDP designations were correct. Twelve hospital designations were incorrect and the majority (10) overestimated hospital capabilities. Of the 100 EMS systems, 7 misclassified hospitals in their TTDP. EMS systems that did not verify their local hospitals' capabilities during TTDP development were more likely to incorrectly categorize a hospital's capabilities (p = 0.001). Conclusions. A small number of EMS systems misclassified hospitals in their TTDP, but most plans accurately reflected hospital capabilities. Misclassification occurred more often in systems that did not consult local hospitals prior to developing their TTDP. The potential of the TTDP to improve communication between EMS agencies and the facilities with which they work has not been fully realized. EMS agencies or systems should verify local hospital capabilities when engaging in destination planning efforts.

"The Neely Conference: Developing Research Criteria to Define Medical Necessity in EMS" convened emergency medical services (EMS) physicians, researchers, administrators, providers, and federal agency representatives to begin the development of a set of uniform triage criteria and outcome measures that could be used to study and evaluate medical necessity among EMS patients. These standardized criteria might be used in research studies examining EMS dispatch and response (e.g., dispatch triage protocols, alternative response configurations), and EMS treatment and transport (e.g., field triage protocols, alternative care destinations). The conference process included review and analysis of the literature, expert judgment, and consensus building. There was general agreement on the following: 1. Any dispatch triage or field triage system that is developed must be designed to offer patients alternatives to EMS, not to refuse care to patients. 2. It is theoretically possible to develop a set of clinical criteria for need. Some groups of patients will clearly need a traditional EMS response and other groups will not, but this has yet to be defined. 3. In addition to clinical criteria, certain social and other nonclinical criteria such as pain or potential abuse may be used to justify a response. 4. Communication barriers, patient age, special needs, and other conditions complicate patient assessment but should not exclude patients from consideration for alternate triage or transport. 5. These research questions are important, and standard sets of outcome measures are needed so that different studies and innovative programs can be compared.

The primary goal of the Neely Conference project is to work toward defining a set of research criteria for medical necessity in emergency medical services (EMS). This paper reviews the extant literature on triage and nontransport decisions made in the field by EMS personnel, with emphasis on the methodologies that have been used to date. Two types of medical necessity standards are considered. First, there are triage criteria for determining whether a given patient requires EMS transport to the hospital, or whether an alternative might be appropriate. These triage criteria might be incorporated into protocols that field personnel could apply on scene to determine the best disposition for a given patient. Second, there are the outcome measures against which the decisions made by the field personnel are judged. In some cases, the outcome measure is the judgment of a reviewing emergency physician or nurse, while in others specific outcome measures are used to judge the performance of the criteria and the decision making of the field providers. While review of the literature shows that no "standard" set of triage criteria have been generated or validated in determining medical necessity in EMS, there are certain themes that emerge from the literature, and these themes can likely form the basis of a consensus on elements of a medical necessity criteria that need to be validated and refined. These may include (for triage criteria) vital signs, chief complaints, and physical exam findings, and (for outcome measures) hospital admission, critical events, death, and diagnosis.

Objective. Researchers interested in ensuring appropriate use of emergency medical services (EMS) resources have attempted to define safe and effective protocols for triage either at the time of dispatch or after on-scene evaluation. Published work in this area is difficult to evaluate because protocols and outcome criteria vary from study to study. The goal of the Neely Conference was to bring together EMS experts to define a set of criteria to be used in research studies evaluating dispatch triage and field triage systems. Methods. Thirty-one experts in EMS systems and research attended a day-long workshop to assess the current literature regarding dispatch triage and field triage, and make recommendations to standardize methods used to evaluate future triage protocols. Participants were surveyed during the workshop; consensus analysis techniques were used to determine if a formal consensus was reached. A Bayesian posterior probability of 0.99 was required to consider responses a “consensus.” Results. P...

Some emergency medical services (EMS) systems are interested in considering the possibility of triaging some patients who call an emergency dispatch center to alternatives to the traditional emergency response, but concerns exist about the safety of that triage. In January 2003, the Neely Conference was held in association with the National Association of EMS Physicians annual meeting in Panama City, Florida. The Neely Conference began the process of developing criteria to be used in research studies evaluating dispatch and field triage systems. Various outcome measures have been used, including expert opinion, patient interviews, specific patient complaints, field findings and interventions, and emergency department or hospital outcomes. This commentary reviews the methods used in the current literature to evaluate dispatch triage systems.

Objective. Although the concept of emergency medical services (EMS) has existed for 30 years, there is little scientific evidence validating its impact on morbidity and mortality. A significant barrier to conducting meaningful assessments relates to the lack of reliable and uniform EMS data. The objective of this study was to determine the extent to which states incorporate the Uniform Prehospital EMS Data Elements into statewide EMS data collection systems. Methods. Study investigators requested and compared data elements from all states with a statewide prehospital data collection system. Results. During the study period, 43 states with statewide EMS data collection systems captured, on average, 79% of the Uniform Prehospital EMS Data Set. Variables considered essential to EMS evaluation were more likely collected (84%) than variables considered desirable (72%). Only eight (10%) of the 81 uniform data elements are collected by all 43 participating states. Conclusions. Findings suggest that related EMS d...

This is the authors' accepted manuscript, post peer-review. The original published version can be found at: http://dx.doi.org/10.1080/01626620.2001.10463071