CONCEPTS
Uniform Prehospital Data Elements and
From the Arizona Emergency
Medicine Research Center, University
of Arizona, Tucson*; EM5 Data
Systems, Inc, Phoenix, Arizona~;
Department of Emergency Medicine,
Stanford UniversitS, EMS Bureau,
Montana Department of Health and
Environmental 5dences, State of
Montana II, EMS Division, National
Highway Traffic Safety
Administration~; Division of Trauma
and EMS, Health Resources and
Services Administration#; and
Uniformed Services University* *;
National Center for Injury Prevention
and Control, Centersfor Disease
Control and Prevention"~; and PACE
Evaluation, SepuIveda Veterans'
Administration Medical Center,
Sepulveda, California.~
Receivedfor publication
November 9, 1994. Accepted for pub-
lication November 14, 1994.
Fundingfor this project was supplied
by NHTSA, contract no.
DTNH22-92-C-05314, Uniform
Prehospital EMS Data Conference.
Copyright © by the American College
of Emergency Physicians.
APRIL 1995 25:4 ANNALS OF EMERGENCY MEDICINE
Definitions: A Report From the Uniform
Prehospital Emergency Medical Services Data
Conference
Daniel Spaite, MD, FACEP*
Ronald Benoit, BS*
Douglas Brown, CEP*
Richard Cales, MD, FACEP§
Drew Dawsonll
Chuck Glass ~
Christoph Kaufmann, MD, MPH,
FACS# **
Daniel Pollock, MD #
Susan Ryan11
Elizabeth M Yano, PhD§§
One of the distinct and universal aspects of emergency medical
service (EMS)is the belief that before its implementation many
people were dying or being killed by ill-equipped, poorly trained
"hearse drivers" and that this tragic state of affairs has been
rectified by the advances in the prehospital phase of care.
Except for cases of nontraumatic, out-of-hospital cardiac arrest
there is almost no convincing scientific evidence to prove that
prehospital care has had an impact on morbidity or mortality. At
the very foundation of this problem is the lack of a set of broad-
based, well-conceived, accurate, reliable, uniform EMS data.
Many attempts have been made to develop a uniform EMS data
set, but without a national consensusthese have not achieved
wide distribution. In 1992, with the assistance of the National
Highway Traffic Safety Administration, the national consensus
process began with a series of meetings involving many EMS
agencies and organizations. This culminated in August 1994
with the development of an 81-item uniform EMS data set. We
detail the prior attempts at data set development and outline the
process leading to the this uniform, national EMS data set.
[Spaite D, Benoit R, Brown D, Cales R, Dawson D, Glass C,
Kaufmann C, Pollock D, Ryan S, Yano EM: Uniform prehospital
data elements and definitions: A report from the uniform prehos-
pital emergency medical services data conference. Ann Emerg
Med April 1995;25:525-534.]
INTRODUCTION
The development of modern emergency medical services
(EMS) systems has had a profound impact on the expecta-
tions of American citizens of immediate access to and con-
tinuous availability of emergency medical care outside the
confines of traditional health care facilities. The develop-
ment of sophisticated prehospital care systems has also
created a unique culture among those who provide this
care. One of the distinct and nearly universal aspects of
this culture is the intense belief that in the "old days,"
52 5
EMS DATA
Spaite et aI
people died because of or were killed by ill-equipped,
poorly trained "hearse drivers," a state of affairs, most
assume, that has been rectified by the advent of modern
EMS systems. Advances in prehospital treatment have
markedly decreased the morbidity and mortality due to
serious illness and injury Furthermore, many believe that
providing care in the field is more advantageous to the
patient than subsequent inhospital care, even if it is opti-
mal. This sense of a lifesaving mission has captured public
interest and commanded societal resources that can only
be measured in the tens of billions of dollars over the past
two decades.
Amazingly, except for the case of nontraumatic, out-
of-hospital cardiac arrest in the urban setting, there is
almost no convincing scientific evidence to prove that
prehospital medical care has had an impact on the mor-
bidity or mortality of illness or i n j u ~ At the very founda-
tion of this problem lies the lack of a broad-based, well-
conceived, accurate, reliable collection of uniform EMS
data.
One of the most fundamental of all current needs in
EMS is access to prehospital patient and system informa-
tion from the wide variety of systems that exist in this
country. Without uniform EMS data, there is no hope that
the many pressing questions surrounding outcome,
impact, and cost-effectiveness will be answered. Akhough
[he mere existence of a national uniform data set and defi-
nitions alone is not sufficient to answer such questions,
the absence of one makes it impossible.
THE HISTORY OF EMS DATA COLLECTION
To fully appreciate the problems related to [he lack of
EMS data collection, it is important to recognize that this
lack is not a new issue. The landmark paper "Accidental
Death and Disability: The Neglected Disease Of Modern
Society," published in 1966 by the National Academy of
Sciences (NAS) and the National Research Council (NRC),
firs[ noted the lack of adequate prehospital data
collection:
Data are lacking on which to determine the number of individuals
whose lives are lost or injuries are compounded by misguided
attempts at rescue or first aid, absence of physiciansat the scene of
injury, unsuitable ambulanceswith inadequate equipment and
untrained attendants, lack of trafficcontrol, or the lack of voice
communicationsfacilities.~
The paper recommended the development of hospital-
based trauma registries [o collect information from both
the prehospital and hospital settings "as a mechanism for
526
the continuing description of the natural history of the
various forms of injuries."
The first federal legislation to address EMS, the High-
way Safety Act of 1966 (much of which was based on the
NAS/NRC paper) was essentially devoid of language
directed at the formation of prehospital data collection
systems. However, EMS system evaluation guidelines,
based on demonstration projects, were published in 1974
by the National Highway Traffic Safety Administration
(NHTSA) in the Highway Safety Program Manual 11 and
were recommended to the Governors' Highway Safety
Representatives for use in their EMS programs. On the
basis of these guidelines and demonstration projects in
New York, NHTSA published specific ambulance and
emergency department report forms in Appendix S in the
Highway Safety Program Manual 11. But, as Boyd points
out, "These funds, except in few i n s t a n c e s . . , did not
stimulate the development of medically accountable EMS
systems of care. ''2
The first federal legislation to specifically address data
collection in EMS was the Emergency Medical Services
System Act of 1973 (EMSSA). This legislation stimulated
comprehensive EMS systems development throughout the
nation and stipulated that every EMS system comprise 15
mandatory system components• Component 11 was
"Standard Record Keeping," which was to:
provide for a standardized patient record keeping system
• . .
meeting appropriate standards as established by the Secretary,
which records shall cover the treatment of the patient from initial
entry into the system through his discharge from it, and shall be
consistent with ensuing patient records used in follow-up care
and rehabilitation of the patient•
NHTSA and the Department of Health and Human
Services (DHH) proceeded to encourage and urge their
respective EMS constituencies to use prescribed standard
data elements for EMS reporting and evaluation.
Each regional system was to provide for a coordinated
record keeping system including linked prehospital, hos-
pital, and critical care records. To facilitate patient care
evaluation, the data elements were also to be consistent
with those in patient records used in follow-up care and
rehabilitation. The minimal patient record was to
comprise dispatcher records, ambulance records (both
basic life support and advanced life support [ALS]), and
all hospital records. Key elements of a coordinated EMS
record were specified. However, the EMS regions that
applied for or received federal funds experienced major
problems in implementing this component. The myriad
problems earned this component the reputation of being
the most difficult of all the EMS systems components to
ANNALS OF EMERGENCY MEDICINE 25:4 APRIL 1995
EMS DATA
5paite et al
implement) Ironically, despite the proposed complexity
and significance of "standard record keeping," none of the
seven federal EMS Demonstration Projects, which
preceded EMSSA, evaluated the feasibility of carrying out
this component.
While developing the Standard Record Keeping com-
ponent, the federal government contracted with Macro
Systems, Inc, to develop the original EMS minimum data
set (MDS). The Health Services Administration (HSA),
which was responsible for implementing the EMSSA,
determined it was not feasible to impose standardized
recordkeeping forms and procedures on grant
recipients. <5 Consequently, HSA recommended that 20
data elements serve as a minimum data set for all EMS
systems. 5 The data set was never widely distributed or
officially incorporated into EMS data collection systems
to any significant degree. Furthermore, it failed to
resolve problems associated with data collection or anal-
ysis. However, a systems evaluation workbook was pub-
lished in 1976 to promote efficient data collection
techniques and appropriate evaluation methods#
In the 1976 amendments to EMSSA, Congress mandated
a study to identify the category of patients to be included
in a uniform reporting system that would evaluate the
effectiveness of EMS in reducing death and disability
Congress expressed the hope that "the development of a
uniform reporting system would discourage the develop-
ment of a multiplicity of incompatible reporting systems
that might prove inadequate for evaluating the effective-
ness of EMS systems and result in unnecessary duplica-
tion of effort."
In 1977, the HSA responded to the congressional man-
date by initiating "program abstracts" to evaluate EMS
systems. The mandatory abstracts specified groups of
patients that received care in the seven critical care areas
of EMS systems (major trauma, burns, spinal cord
injuries, myocardial infarction, poisonings, high-risk
obstetrics/neonates, psychiatric) would be used as "trac-
ers" for outcome determination. The outcomes of these
patients would supposedly help the evaluation of the
effectiveness of an entire EMS system. In a 1978 study
performed to validate the data abstraction method, it
was determined that statistics describing the incidence of
patients failing within the critical care categories could
be reliably collected from EMS systems, thereby meeting
HSA reporting requirements. However, it was also con-
cluded that HSA had failed to clearly state the data defini-
tions and instructions necessary to collect appropriate
data to evaluate outcomes. 7
APRIL 1995 25:4 ANNALS OF EMERGENCY MEDICINE
In 1981, supported by a grant from the NHTSA, the
Health Operations Research Group at the University of
Pittsburgh, through the Pennsylvania EMS Division,
examined the feasibility and components of an ALS
MDS for the Commonwealth of Pennsylvania. s The
research group used a standardized consensus format
to develop an extensive and comprehensive list of 86
data points for inclusion on the patient care record
(PCR). Despite its comprehensive nature, this MDS was
never significantly used. A National EMS Management
Information Workshop was convened in 1983 to evalu-
ate issues in EMS management information systems
(MIS). Two of the four paper sessions focused on data
needs and data sources. Most of the papers presented
described the development of statewide uniform EMS
PCRs9-1 t and noted that linkage with hospital discharge
data and police records would facilitate system evalua-
tion.9,zl, 12
In the late 1980s, the American Society for Testing and
Materials (ASTM) Committee F-30.03.03 on EMS/MIS
attempted to develop an MDS. Although several years of
committee work yielded many drafts, the ASTM consen-
sus process did not lead to a final, approved product. In
1990, Hedges and Joyce proposed an MDS based on
much of the aforementioned historical work. ~3 Despite
these attempts to develop an MDS, a forum was never
provided to assure broad input from the enormous cadre
of stakeholders. Thus none of the data sets received
widespread attention at the local, state or, regional level.
Because it had become clear that failure to provide an
effective process at the national level would doom MDS
development to an endless cycle of failure, NHTSA
solicited support from other federal agencies to aid in
developing a consensus forum (Table 1).
THE PURPOSES OF PREHOSPITAL
DATA COLLECTION
The main purposes of prehospital data collection include
the following. (1) Data collected in the field represent
the legal documentation of the patient encounter.
Independent of all other issues, this information serves
the primary purpose of being the prehospital patient
medical record. (2) In many systems, prehospital infor-
mation is necessary for billing of services provided to
the patient. Thus the financial resources to maintain the
system rely directly on the collection of this information.
(3) The PCR serves as the foundation for most system
quality-improvement programs. (4) Accurate prehospital
data collection is fundamental to all system evaluations
52 7
EMS DATA
Spaite et al
and alterations. (5) Research necessary to answer impor-
tant questions depends on prehospital data. This is espe-
cially true in attempts to identify cost-effectiveness and
impact on patient outcome. (6) The evaluation of broad
public health issues is growing increasingly dependent on
prehospital data. (7) The ability to properly allocate soci-
etal resources must be tied to accurate prehospital infor-
mation analyzed from local, regional, state, and national
perspectives.
OBSTACLES TO UNIFORM PREHOSPITAL DATA
COLLECTION AND USE
Despite a widespread sense among EMS professionals that
uniform data collection and reporting are important to
the future of EMS, little progress has been made in this
endeavor. The main reason is that EMS funding, admin-
istration, expansion, system maintenance, protocol
development, and medical direction often remain under
local control. Few would argue that this should change,
because of the diversity of geography, demographics,
resources, and patient populations found among EMS
systems. Consequently, few local system administrators
or medical directors have a perspective or concern beyond
the problems and issues that they face in their own small
subsystems. Thus nearly no one has been concerned
with helping answer questions that are not of obvious
local importance. In essence, each system °'owns" its own
data (what is collected, how it is collected, how it is
used), and its global importance is an issue of little con-
cern. Unfortunately, many essential questions can onIy
be answered by the compilation and sharing of meaning-
ful information from many EMS microcosms. 14-~6
Limited resources pose a second barrier to uniform
data collection and reporting. This is true on several
fronts. First, large-scale collection, reporting, and aggre-
Table 1.
Sponsoringfederal agencies.
National Highway Traffic Safety Administration, US Department of Transportation
The following organizations of the US Department of Health and Human Services:
Division of Trauma and Emergency Medical Systems, Health Resources and
Services Administration
National Center for Injury Prevention and Control, Oenters for Disease Control
NationaF Heart, Lung, and Blood Institute, National Institutes of Health
Maternal and Child Health Bureau, Health Resources and Services Administration
Office of Rural Health Policy, Health Resources and Services Administration
Office of Coverage and Eligibility Policy, Health Care Finance Administration
Office of Science and Data Development, Administration for Health Care Policy
and Research
US Fire Administration, Federal Emergency Management Agency
528
gation of data would require substantial financial resources.
Because such resources have not been forthcoming from
federal or state governments, funding would have had to
come from local and regional entities. Clearly, this has
not occurred; nor would it have been predicted, for rea-
sons detailed earlier. Second, even if adequate financial
resources were available, few local EMS system personnel
have the information-management experience or expertise
in development and implementation to produce a system
that is appropriate and responsive to local and national
needs. Third, even in systems where appropriate expertise
exists, few are associated with research institutions
where experience in system evaluation, medical infor-
matics, statistical analysis, and cost-effectiveness analysis
exists.lZ It is not surprising that local EMS agencies have
seen little need to develop sophisticated and expensive
data collection processes that would remain virtually
unused.
The final barrier to the development of uniform data
collection and reporting has been the lack of a lead federal
agency to direct a national consensus process. To remove
this barrier and to help assure widespread acceptance,
NHTSA built a coalition of federal agencies and nonfed-
eral organizations. With a national, consensus-based uni-
form data set established, it is hoped that substantial
efforts will be made to deal with the other barriers at the
federal, state, regional, and local levels.
DEVELOPMENT OF THE DATA SET STRAWMAN
The Uniform Prehospital EMS Data Conference was con-
vened in an effort to establish a consensus-based national
EMS data set. During the development process, attendees
evaluated current prehospital data elements, building and
refining definitions as appropriate. The conference estab-
lished, as a goal, the development of consensus statements
Table 2.
No@derd stakeholder groups represented ~n planning.
American Academy of Pediatrics
American Ambulance Association
American College of Emergency Physicians
American College of Surgeons
American Hospital Association
American Society for Testing Materials
EMS Data Systems Incorporated
National Association of EMS Physicians
National Association of EMTs
National Association of State EMS Directors
National Council of State EMS Training Coordinators
International Association of Fire Chiefs
ANNALS OF EMERGENCY MEDICINE 25:4 APRIL 1995
EMS D A T A
Spaite et aI
that would lead to the implementation of a widely accepted
and utilized data set to be modified and refined through
research.
The national consensus process began in 1992 with
the convening of a series of meetings including many
stakeholder organizations (Tables 1 and 2). During this
process, a subgroup of the planning committee was given
the task of developing a "strawman" document to include
potential "core" and "supplemental" data elements and
definitions. A conceptual change led to the terminology of
uniform data set (UDS) instead of minimum data set. This
change reflected several issues: First, the term "minimum"
was a misnomer, given the broad scope of the project and
the predicted final product. With the inclusion of both
core and supplemental elements, the data set could no
longer be considered minimum. Second, the term "mini-
mum" might imply a relatively fixed, if not stagnant,
group of elements. It was clearly understood from the out-
set that the consensus group product would only repre-
sent a beginning, with the full intent for future evaluation,
revision, and improvement. Third, dealing only with the
minimum data set would continue to leave the supple-
mental elements in the same quagmire of local, regional,
and state variation that had typified the previous data set.
Finally, compatibility with the monumental work done by
the Utstein Consensus Conference zs for prehospital car-
diac arrest data was important, even though some of these
data elements could not be considered core for many local
E M S systems.
CRITERIA FOR INCLUSION OF PREHOSPITAL
DATA ELEMENTS
During UDS strawman development, meetings of the data
set development task group provided for extensive discus-
sion of each potential data element. The rationale for inclu-
sion of a given data element are listed in Table 3. For a data
element to be regarded as core, it was mandatory that it be
considered an essential part of the medical record in any
local EMS system. Many of the core elements had other
rationales for inclusion, but appropriateness for the medical
record was a prerequisite. Although one of the intended
uses of the uniform data is evaluation of system-related
questions, usefulness for evaluative or epidemiologic pur-
poses was not sufficient to qualify a data element as core.
The rationale was simple: If data elements were considered
core despite the fact that their primary usefulness was for
research or evaluation, the likelihood of their widespread
acceptance would be compromised.
APRIL 1995 25:4 ANNALS OF EMERGENCY MEDICINE
The inclusion of supplemental data elements in the
consensus process was important. Although some might
argue that only core elements should have been included,
exclusion of the supplemental elements would have been
detrimental in several ways. First, many of the supple-
mental elements are extremely important for EMS system
evaluation and quality improvement at the local, regional,
and state levels. However, many of the supplemental ele-
ments could not realistically be considered core because
it would be unfeasible to collect them in all systems. Second,
many riMS systems alrea@ collect many of the supplemental
elements. Failure to include these as a part of the uniform
data set might discourage systems from continuing to
collect this important information. Third, inclusion of the
supplemental data elements may serve to stimulate future
improvements in EMS data collection. We hope that many
EMS systems will consider collecting some or all of the
supplemental elements in an effort to provide more detailed
and useful information for quality improvement and
research. Finally, inclusion of the supplemental elements
may provide valuable insight into future core elements.
THE UNIFORM PREHOSPITAL EMS DATA
ELEMENT CONFERENCE
In August 1993, the consensus conference convened in
Arlington, Virginia. A diverse group of participants repre-
sented essentially every conceivable organization with an
interest in EMS. The data set strawman was made avail-
able to all conference participants before their arrival. A
National Institutes of Health consensus process was used
to develop the final product. 19 Aided by the Data Set
Development Task Group, a panel of 12 expert referees
(Table 4) heard testimony during open forums on each of
the data elements and definitions. Having heard the
extensive testimony, the expert panel convened to develop
the final data set and definitions (Appendix). It should be
noted that the consensus panel changed the term "core" to
~essential" in the final document. According to the con-
sensus panel, an essential data element is one that is cru-
Table 3.
Rationale for inclusion in data set.
Medical record
System evaluation
Quality improvement
Billing
Medicolegal
Research
529
EMS DATA
5paite et aI
cial for the basic operations of an EMS service and that
can serve a purpose at the regional or national level. The
term "supplemental," which had been used by the data set
development task group, was changed to "desirable." The
panel noted that desirable elements may well be critical to
local operations but may not be considered critical in all
jurisdictions or situations. One significant advantage to
this change is the fact that the terms are both descriptive
and essentially self-defining.
It was the consensus of the panel that these recommen-
dations should be implemented at the state, regional, or
local level as appropriate. The purpose of a uniform data
set and definitions is to provide common terminology and
definitions to be used in the evaluation of EMS. Although
the data set is useful in describing the prehospital aspects
of care, it lacks outcome measures that would strengthen
the evaluation process. It is to be considered a first step in
the process of EMS system evaluation.
LINKAGE OF PREHOSPITAL DATA WITH OTHER
INFORMATION SOURCES
Even if prehospital data collection and management
were being performed perfectly on a national scale, it
would not be adequate, because even well-conceived
prehospital databases carried out in a vacuum are of lim-
ited use. Simply stated, prehospital information that
remains unlinked with hospital and autopsy outcome
data has limited meaning. In fact, the failure of this link-
age is one of the main reasons that so little evidence
exists with regard to the impact of prehospital care on
patient outcome. 2°
Although few people involved in the prehospital, hos-
pital, and rehabilitative aspects of patient care would
argue against the importance of linkage, the obstacles to
information sharing are formidable. In addition to the
Table 4.
Composition of conference consensus panel.
State EMS director
State EMS training coordinator
Ambulance service manager--private
EMS manager--public, fire-based
Regional/county EMS manager
EMS medical director
Emergency physician
Emergency nurse
Trauma systems director
Epidemiologist
EMS researcher
Panel chairperson
530
barriers of patient confidentiality and anonymity of agen-
cies and personnel, most EMS agencies do not employ
personnel with the technical expertise to properly link
separate databases. The complexities and logistics of
emergency medical system informatics are certainly not
trivial. It is hoped that the parallel work toward a trauma
care system uniform data set under the auspices of the
Division of Trauma and EMS at the Health Resources and
Services Administration will provide the opportunity to
develop a model for linkage of prehospital and hospital
information. Optimally, future cooperation between fed-
eral and nonfederal agencies will provide the support nec-
essary to successfully deal with this enormous task.
THE FUTURE: IMPLEMENTATION OF THE
UNIFORM PREHOSPITAL DATA SET
As stated previously, the product of the consensus confer-
ence should only be considered a beginning. Although it
is hoped that the substantial progress made by the confer-
ence has yielded a product that is both useful and valuable,
research and evaluation of the UDS must begin immedi-
ately Pilot testing of the data set in frontier, rural, subur-
ban, and urban settings will be necessary to determine the
feasibility of widespread use. In addition, the process of
aggregating, analyzing, and using information at the
regional, state, and federal levels will be extremely impor-
tant. If quality information is gathered but not shared, the
global impact of this data set will be only minimal.
It is important to note that the national conference did
not develop consensus on the data item dictionary. For
instance, the data element "Signs and Symptoms Present"
was discussed and considered during the consensus pro-
cess. It did receive a definition and a priority assignment
of essential. However, the items on the data item content
list (ie, abdominal pain, back pain, childbirth) were not
formal subjects of the consensus conference. Therefore
this article does not include the extensive data dictionary
issues, only cursory comments and examples. The
Division of EMS at NHTSA continues to work with the
consensus panel and the data set development task group
to resolve these remaining issues before publication of the
final federal document. Copies of that document will be
available through the EMS Division of NHTSA.
Finally, the existence of a widely accepted uniform data
set does not ensure that accurate and complete informa-
tion will be collected in the field. 21-22 Much work remains
to be done in evaluating the many barriers to the process
of obtaining high-quality information collected in the pre-
hospital setting. If this process results only in the collec-
ANNALS OF EMERGENCY MEDICINE 25:4 APRIL 1995
EMS DATA
Spaite et al

tion and reporting of a large amount of bad data, it will
simply lead to bad conclusions that are believed with
greater fervency. It is the responsibility of EMS profession-
als at every level to ensure that such a situation does not
occur. Future conferences should be convened to review
the experience of systems that implement the UDS. This
experience, combined with research and evaluation of the
data set, will form the basis for revision and improvement.
It is hoped that this process, along with improved linkage
of information, will yield answers to the fundamental
questions about the cost-effectiveness and outcome
impact of EMS systems.
REFERENCES
1. National Academy of Sciencesand the National ResearchCouncil: Accidental Death and
Disability: The Neglected Disease of MOdernSociety. Washington, DC. September 1966.
2. Boyd DR (ed):A symposium on the Illinois trauma program: A systems approachto the care of
the critically injured. J Trauma1973;13:275,320.
3. Boyd DR: The history of emergencymedical systems (EMS) in the United States of America, in
Beyd DR, Edlich RF, Sylvia M (eds), SystemsApproachto EmergencyMedical Care.Norwalk,
Connecticut, Appleton-Century-Crofts, 1983.
4. Steele R: Developmentof a Minimal Data Set for EmergencyServices Patient RecordKeeping.
Macro Systems, Inc. Preparedfor the Health Services Administration, National Technical
Information Services (NTIS),July 1974.
8. Birch H: Guidelines for Patient Record Keeping Systems for EmergencyMedical Services.Vol
Ih Model System Guidelines for Patient RecordKeeping and Management Reporting. Macro
Systems, Inc. Preparedfor the Health ServicesAdministration, NTIS, September 1974,
6. Evaluationworkbook for EMS. US Department of Health, Educationand Welfare, Public Health
Service, Health Services Administration, Division of EmergencyMedical Services. DHEW
Publications {HSA)76-2021, August 1976.
7. Reliability of accuracy,completeness, and comparability of the emergencymedical services
systems data needed to meet reporting requirements of Public Laws 93-154 and 94-573. Arthur
Young and Co. Final report {draft) submitted to the Health Services Administration January 1980.
8. Wolfe H, Shuman LJ, Esposite G, et ah DevelopmentefALSMinimumDataSetandBLS
Algorithms. University of Pittsburgh, August 1981.
9. Johnson SW: Developmentof a uniform ambulance run report and the use of nominal and del-
phi group process techniques to reach consensus,in DetNefs WC, Ham KS (eds), Proceedingsof
the NationalEMSManagementInformationSystemsWorkshop.Harrisburg, Pennsylvania,
October 1983.
10. Houston J: Consensusdesign and development of an effective, workable management infor-
mation system for a rural EMS system: The Dartmouth system revisited. In Dethlefs WC, Ham KS
(eds}, Proceedingsof the NationalEMSManagementInformationSystemsWorkshop.
Harrisburg, Pennsylvania,October 1983.
11. Ham KS: Consensusdevelopment for identification of data elements and implementation
among diverse regional EMS systems, in Dethlefs WC, Ham KS (ads), Proceedingsof the
NationalEMSManagementInformationSystemsWorkshop.Harrisburg, Pennsylvania,October
1983.
12. Larson D: Statewide collection of EMS-related information: The Utah vehicular trauma study,
in Dethlefs WC, Ham KS (eds), Proceedingsof the NationalEMSManagementInformation
SystemsWorkshop.Harrisburg, Pennsylvania,October 1983.
13. HedgesJR, Joyce SM: Minimum data set for EMS report form: Historical development and
future implications, PrehospDisasterMad 1990;5:383-388.
14. Cummins DO: Section Ih Meving toward uniform reporting and terminology. Ann EmergMed
1993;22:33-36.
15. HedgesJR: Beyond Utstein: Implementation of a multiseurce uniform data base for prehospi-
ta[ cardiac arrest research.Ann EmergMed1993;22:41-46.
16. Cummins RO: The Utstein style for uniform reporting of data from out-of- hospital cardiac
arrest. Ann EmergMad 1993;22:37-40.
17. Spaite DW, ValenzuelaTD, Meislin HW: Barriers to EMS system evaluation: Problemsassoci-
ated with field data collection. PrehospDisasterMad 1993;8(suppl):S35-S40.
18, Cummins RO, ChamberlainDA, Abramsen NS, et at: Recommendedguidelines for uniform
reporting of data from out-of-hospital cardiac arrest: The Utstein style. Ann EmergMed
1991;29:861-874.
19. Guidelines for the selection and management of consensusdevelopment conferences: Office
of Medical Applications of Research,National Institutes of Health.
20. Maid R: The utilization of public health research models in the evaluation of EMS systems.
San Francisco,California, 23rd Annual Meeting of the Society for Academic Emergency
Medicine, May 1993.
21. MossessoVN: The most neglected tool in EMS: The clock. Ann EmergMed1993;22:1311-
1312.
22. Spaite DW, Han[onT, Cfiss EA, et ah Prehospita[data entry compliance by paramedics after
institution of a comprehensiveEMS data collection tool. Ann EmergMeg1990;19:1270-1273.
The authors thank the members of the Data Conference Panel: Chairman, J Michael
Dean, MD; Jim Dowser; Rick Buell; Herbert Garrison, MD; W Briggs Hopson, MD;
Leonard Inch; Chief Jack Krakeel; Ronald MaiD, DO; Peter Pens, MD, FACEP; Wade
Spruill, Jr; Patricia Waller, PhD; and Marie Wilson, RN.
Reprint no. 47/1/62558
No reprints available from the author.

Appendix.
Uniform EMS data elements and definitions.

Data Element Priority Definition Comment

1. Incident address Essential Address (or best approximation) where patient was found Free text
or, if no patient, address to which the unit responded
2. Incident city Essential City or township (if applicable) where patient was found Numeric entry
or to which unit responded (or best approximation}
3. Incident county Essential County or parish (if applicable} where patient was found Numeric entry
or to which unit responded (or best approximation)

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EMS DATA
Spa~te et aZ

Appendix, continued
Data Element Priority Definition Comment

4. Incident state Essential State, territory, or province (or District of Columbia) where Alphanumeric entry
patient was found or to which unit responded
5. Location type Essential Type of location of incident Examples: residence, public building, farm
6. Onset date Desirable Date of onset of symptoms or injury date May differ from the date of EMS
response. May be numerically coded.
7. Onset time Desirable Time of onset of symptoms or injury time
8. Date incident reported Essential Date the call was first received by a public safety
answering point (PSAP) or other designated entity
9. Time incident reported Essential Time call was first received by PSAP or other Starting point of the EMS response. Measure-
designated entity ment in seconds and clock synchronization
strongly encouraged.
10. Time dispatch notified Essential Time of first connection with EMS dispatch Permits assessment of delays between time inci-
dent reported and the notification of EMS dis-
patch. Measurement in seconds and clock sy-
chronization strongly encouraged.
11. Date unit notified Desirable Date on which response unit is notified by EMS dispatch May be numerically coded.
12. Time unit notified Essential Time at which response unit is notified by EMS dispatch Permits measurement of response
in seconds and clock synchronization strongly encouraged. and possible delays. Measurement
13. Time unit responds Essential Time at which response unit begins physical motion Permits measurement of interval he~een notifi-
cation and actual mobilization of response unit.
Measurement in seconds and clock synchroniza-
tion strongly encouraged.
14. Time of arrival at scene Essential Time EMS unit stops physical motion at scene (last place Measurement in seconds and clock synchroniza-
that the unit or vehicle stops before assessing patient) tion strongly encouraged.
15. Time of arrival at patient Desirable Time at which response personnel establish direct Identifies earliest time at which EMS care can
contact with patient actuafly begin. Measurement in seconds
and clock synchronization strongly encouraged.
16. Time unit leaves scene Essential Time when response unit begins physical motion from scene Measurement in seconds and clock synchroniza-
tion strongly encouraged.
17. Time of arrival at destination Essential Time when patient arrives at destination or transfer point May reflect time of rendezvous with another EMS
unit. Measurement in seconds and clock syn-
chronization strongly encouraged.
18. Time back in service Essential Time that response unit is back in service and available for Permits measurement of total out-of-service
response interval.
19. Lights and sirens to scene Essential Use of lights and sirens en route to scene Yes, no, upgraded, downgraded
20. Service type Essential Type of service requested Items such as scene, interfacility, standby
21. Incident number Essential Unique number for each incident reported to dispatch Alphanumeric entry
22. Responsenumber Essential Unique number for each individual response by a Each unit responding to a single incident would
response unit to an incident have the same incident number but a unique
response number.
23. PCR number Essential Unique number for each PCR
24. Agency/unit number Essential Number identifies the agency and unit responding to Useful in constructing agency or unit-specific
an incident reports.
25. Vehicle type Essential Type of vehicle that responded to an incident Examples: ground, rotorcraft, fixed-wing, other.
26. First crew member number Essential Personnel certification/license number for first crew Identifies personnel involved in response,
member patient care, or both.
27. Second crew member number Essential Personnel certification/license number for second crew
member
28. Third crew member number Desirable Personnel certification/license number for third crew A given agency may desire to list three or mere
member personnel. The ability to list at least two is
essential.
29. Crew member l type Essential Personnel certification/license level of crew member Examples: first responder, emergency medical
technician basic, paramedic, nurse
30. Crew member 2 type Essential Personnel certification/license level of crew member
31. Crew member 3 type Desirable Personnel certification/license level of crew member
32. Patient name Essential Patient name Free text
33. Patient street address Desirable Patient's street address (if applicable) Free text; patient's place of residence, if known
34. City of residence Desirable Patient's city or township of residence (if applicable) Numeric entry
35. County of residence Desirable County or parish where patient resides (if applicable) Numeric entry
36. State Desirable State, territory, or province (or District of Columbia) Alphanumeric entry
where patient resides

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EMS DATA
5pa~te et aI

Appendix, continued
Data Element Priority Definition Comment

37. Zip code of resident Essential Zip code of patient's residence Numeric entry; county can be derived from zip
code.
38. Telephone number Desirable Patient's main telephone number Numeric entry
39. Social Security number Desirable Patient's Social Security number Numeric entry, nine digits
40. Date of birth Essential Patient's date of birth Numeric entry
41. Age Desirable Patient's age or best approximation Numeric entry, three-digit field
42. Gender Essential Gender of patient Male, female, unknown
43. Race/ethnicity Essential Patient's ethnic origin American Indian/Alaska Native; Asian/Pacific
islander; black non-Hispanic, black
Hispanic, white non-Hispanic, white Hispanic,
unknown
44. Destination/transferred to Essential Health care facility or prehospital unit/home that Examples: hospital (specify), medical office,
received patient from EMS responder providing record morgue, airport, other EMS responder
45. Destination determination Essential Reason a transport destination was selected Examples: patient choice, closest facility, man-
aged care, specialty resource center
46. Lights, sirens used from scene Essential Use of lights, sirens, or both from the scene Yes, no, upgraded, downgraded
47. Incident/patient disposition Essential Result of EMS response Examples: canceled, patient refusal, no treat-
ment required, treated and transferred to other
EMS provider, treated and transported
48. Chiefcomplaint Desirable Statement of problem by patient or other person Free text
49. Causeof injury Essential External cause of injury Items should be consistent with E-codes in
ICD-9. Although such detail may not be appro-
priate, the data items should be compatible
with and collapsible to the E-code cause of
injury list.
50. Provider impression Essential Previder's clinical impression that led to the management Primary, single most pertinent clinical assess-
given to the patient (treatments, medications, procedures) ment. Examples: abdominal pain, airway
obstruction, allergic reaction
51. Preexisting condition Essential Preexisting medical conditions known to the provider Examples: asthma, diabetes, chronic obstructive
pulmonary disease
52. Signsand symptoms Essential Signs and symptoms reported to or observed by provider Examples: back pain, bloody stools, headache.
Should be compatible with ICD-9 codes.
53. Injury description Essential Olinical description of injury type and body site List of all injuries sustained by injury type
(amputation, blunt, gunshot) and body site
54. Injury intent Desirable Intent of individual inflicting injury Intentional, unintentional, unknown, not
applicable
55. Safety equipment Essential Safety equipment in use by patient at time of injury Examples: none used, shoulder belt only, child
safety seat, helmet, eye protection
56. Factorsaffecting Desirable Special circumstances affecting EMS response or delivery Examples: adverse weather, vehicle problems,
EMS delivery of care of care language barrier, hazardous environment,
combative patient
57. Alcohol/drug use Essential Suspected alcohol or drug use by patient Yes, no, unknown, not applicable
58. Time of first CPR Desirable Best estimate of time of first CPR
59. Providerof first CPR Desirable Person who performed first CPR on patient Bystander, EMS responder, not applicable,
unknown
60. Time CPR discontinued Desirable Time at which medical control or responding EMS
unit terminated resuscitation efforts in the field
61. Time of witnessed Desirable Best estimate of time of witnessed cardiac arrest
cardiac arrest (if known and applicable)
62. Witness of cardiac arrest Desirable Person who witnessed the cardiac arrest Bystander, EMS responder, not witnessed, not
applicable, unknown
63. Timeof first Desirable Time of first defibrillatory shock Measurement in seconds and clock synchroniza-
defibrillatory shock tion strongly encouraged
64. Returnofspon- Desirable Whether a palpable pulse or blood pressure was
taneous circulation restored after cardiac arrest and resuscitation in the field.
65. Pulserate Essential Patient's palpated or auscultated pulse rate, expressed in Numeric, not obtained, unknown, not applicable
number per minute
66. Initial heart rhythm Desirable Initial monitored heart rhythm as interpreted by Use current advanced cardiac life support (ACLS)
EMS personnel terms and definitions.
67. Rhythmat destination Desirable Monitored cardiac rhythm on arrival at destination Use current ACLS terms and definitions.
68. Respiratory rate Essential Unassisted patient respiratory rate, expressed as number per
minute

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Spaite et al

Appendix, continued
Data Element Priority Definition Comment
69. Respiratory effort Essential for Patient's respiratory efforc Normal; increased, not labored; increased and
children, de- labored or decreased and fatigued; absent;
sirablefor adults not assessed
70. Systolic blood pressure Essential Patient's systolic blood pressure
71. Diastolic blood pressure Desirable Patient's diastolic blood pressure
72. Skinperfusion Essential for Patient skin perfusion, expressed as normal
children, de- or decreased
sirable for adults
73. Glasgow eye-opening Essential Patient's eye-opening component of the Glasgow Coma Scale
component
74. Glasgow verbal component Essential Patient's verbal component of the Glasgow Coma Scale
75. Glasgow motor component Essential Patient's motor component of the Glasgow Coma Scale
76. Glasgow Coma Desirable Patient's total Glasgow Coma Scale score (total)
77. RevisedTrauma Score Desirable Patient's Revised Trauma Score
78. Procedureor treatment name Essential Identification of procedure attempted of performed on patient
79. Procedureattempts Desirable Total number of attempts for each procedure attempted, Compatible with ICD-9 procedure classification
regardless or success (P codes)
80. Medication name Essential Medication name
81. Treatment authorization Desirable Indicates the type, if any, of treatment authorization Examples: protocol (standing orders), on-
line (radio/telephone), on-scene physician,
written orders, unknown, not applicable

934 ANNALS OF EMERGENCY MEDICINE 25:4 APRIL 1995