WIXLIB

www.6&(06'DWD.orgData DictionaryBased on theNHTSA Version 2.2.1(2006)Found at:www.NEMSIS.org

NHTSA Uniform PreHospital EMS Dataset Version 2.2.1National EMS Information Agency Project (NEMSIS)www.nemsis.org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

E01 01E01 02E01 03E01 04E02 01E02 02E02 03E02 04E02 05E02 06E02 07E02 08E02 09E02 10E02 11E02 12E02 13E02 14E02 15E02 16E02 17E02 18E02 19E02 20E03 01E03 02E03 03E04 01E04 02E04 03E05 01E05 02E05 03E05 04E05 05E05 06E05 07E05 08E05 09Patient Care Report NumberSoftware CreatorSoftware NameSofware VersionEMS Agency NumberIncident NumberEMS Unit (Vehicle) Response NumberType of Service RequestedPrimary Role of the UnitType of Dispatch DelayType of Response DelayType of Scene DelayType of Transport DelayType of Turn-Around DelayEMS Unit/Vehicle NumberEMS Unit Call Sign (Radio Number)Vehicle Dispatch LocationVehicle Dispatch ZoneVehicle Dispatch GPS LocationBeginning Odometer of Responding VehicleOn-Scene Odometer of Responding VehiclePatient Destination Odometer of Responding VehicleEnding Odometer Reading of Responding VehicleResponse Mode to SceneComplaint Reported by DispatchEMD PerformedEMD Card NumberCrew Member IDCrew Member RoleCrew Member LevelIncident or Onset Date/TimePSAP Call Date/TimeDispatch Notified Date/TimeUnit Notified by Dispatch Date/TimeUnit En Route Date/TimeUnit Arrived on Scene Date/TimeArrived at Patient Date/TimeTransfer of Patient Care Date/TimeUnit Left Scene Date/Time SCData Element(Red NEMSIS National EMS Database Elements)NationalDatabaseSouth Carolina State EMS DatasetXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXPage 1 of 9

E05 10E05 11E05 12E05 13E06 01E06 02E06 03E06 04E06 05E06 06E06 07E06 08E06 09E06 10E06 11E06 12E06 13E06 14E06 15E06 16E06 17E06 18E06 19E07 01E07 02E07 03E07 04E07 05E07 06E07 07E07 08E07 09E07 10E07 11E07 12E07 13E07 14E07 15E07 16Patient Arrived at Destination Date/TimeUnit Back in Service Date/TimeUnit Cancelled Date/TimeUnit Back at Home Location Date/TimeLast NameFirst NameMiddle Initial/NamePatient's Home AddressPatient's Home CityPatient's Home CountyPatient's Home StatePatient's Home Zip CodePatient’s Home CountrySocial Security NumberGenderRaceEthnicityAgeAge UnitsDate of BirthPrimary or Home Telephone NumberState Issuing Driver's LicenseDriver's License NumberPrimary Method of PaymentCertificate of Medical NecessityInsurance Company ID/NameInsurance Company Billing PriorityInsurance Company AddressInsurance Company CityInsurance Company StateInsurance Company Zip CodeInsurance Group ID/NameInsurance Policy ID NumberLast Name of the InsuredFirst Name of the InsuredMiddle Initial/Name of the InsuredRelationship to the InsuredWork-RelatedPatient’s Occupational Industry SCData Element(Red NEMSIS National EMS Database Elements)NationalDatabaseSouth Carolina State EMS DatasetXXXXXXXXXXXX XXXXXX XXXXPage 2 of 9

E07 17E07 18E07 19E07 20E07 21E07 22E07 23E07 24E07 25E07 26E07 27E07 28E07 29E07 30E07 31E07 32E07 33E07 34E07 35E07 36E07 37E08 01E08 02E08 03E08 04E08 05E08 06E08 07E08 08E08 09E08 10E08 11E08 12E08 13E08 14E08 15E09 01E09 02E09 03Patient’s OccupationClosest Relative/Guardian Last NameFirst Name of the Closest Relative/ GuardianMiddle Initial/Name of the Closest Relative/ GuardianClosest Relative/ Guardian Street AddressClosest Relative/ Guardian CityClosest Relative/ Guardian StateClosest Relative/ Guardian Zip CodeClosest Relative/ Guardian Phone NumberClosest Relative/ Guardian RelationshipPatient's EmployerPatient's Employer's AddressPatient’s Employer’s CityPatient’s Employer’s StatePatient’s Employer’s Zip CodePatient's Work Telephone NumberResponse UrgencyCMS Service LevelCondition Code NumberICD-9 Code for the Condition Code NumberAir Ambulance Modifier for Condition Code NumberOther EMS Agencies at SceneOther Services at SceneEstimated Date/Time Initial Responder Arrived on SceneDate/Time Initial Responder Arrived on SceneNumber of Patients at SceneMass Casualty IncidentIncident Location TypeIncident Facility CodeScene Zone NumberScene GPS LocationIncident AddressIncident CityIncident CountyIncident StateIncident ZIP CodePrior AidPrior Aid Performed byOutcome of the Prior AidSCData Element(Red NEMSIS National EMS Database Elements)NationalDatabaseSouth Carolina State EMS Dataset XXXXXXXXXXXX XXXXXXXX Page 3 of 9

E09 04E09 05E09 06E09 07E09 08E09 09E09 10E09 11E09 12E09 13E09 14E09 15E09 16E10 01E10 02E10 03E10 04E10 05E10 06E10 07E10 08E10 09E10 10E11 01E11 02E11 03E11 04E11 05E11 06E11 07E11 08E11 09E11 10E11 11E12 01E12 02E12 03E12 04E12 05Possible InjuryChief ComplaintDuration of Chief ComplaintTime Units of Duration of Chief ComplaintSecondary Complaint NarrativeDuration of Secondary ComplaintTime Units of Duration of Secondary ComplaintChief Complaint Anatomic LocationChief Complaint Organ SystemPrimary SymptomOther Associated SymptomsProviders Primary ImpressionProvider’s Secondary ImpressionCause of InjuryIntent of the InjuryMechanism of InjuryVehicular Injury IndicatorsArea of the Vehicle impacted by the collisionSeat Row Location of Patient in VehiclePosition of Patient in the Seat of the VehicleUse of Occupant Safety EquipmentAirbag DeploymentHeight of FallCardiac ArrestCardiac Arrest EtiologyResuscitation AttemptedArrest Witnessed byFirst Monitored Rhythm of the PatientAny Return of Spontaneous CirculationNeurological Outcome at Hospital DischargeEstimated Time of Arrest Prior to EMS ArrivalDate/Time Resuscitation DiscontinuedReason CPR DiscontinuedCardiac Rhythm on Arrival at DestinationBarriers to Patient CareSending Facility Medical Record NumberDestination Medical Record NumberFirst Name of Patient's Primary PractitionerMiddle Name of Patient's Primary Practitioner SCData Element(Red NEMSIS National EMS Database Elements)NationalDatabaseSouth Carolina State EMS DatasetXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXPage 4 of 9

E12 06E12 07E12 08E12 09E12 10E12 11E12 12E12 13E12 14E12 15E12 16E12 17E12 18E12 19E12 20E13 01E14 01E14 02E14 03E14 04E14 05E14 06E14 07E14 08E14 09E14 10E14 11E14 12E14 13E14 14E14 15E14 16E14 17E14 18E14 19E14 20E14 21E14 22E14 23Last Name of Patient's Primary PractitionerAdvanced DirectivesMedication AllergiesEnvironmental/Food AllergiesMedical/Surgical HistoryMedical History Obtained FromImmunization HistoryImmunization DateCurrent MedicationsCurrent Medication DoseCurrent Medication Dosage UnitCurrent Medication Administration RoutePresence of Emergency Information FormAlcohol/Drug Use IndicatorsPregnancyRun Report NarrativeDate/Time Vital Signs TakenObtained Prior to this Units EMS CareCardiac RhythmSBP (Systolic Blood Pressure)DBP (Diastolic Blood Pressure)Method of Blood Pressure MeasurementPulse RateElectronic Monitor RatePulse OximetryPulse RhythmRespiratory RateRespiratory EffortCarbon DioxideBlood Glucose LevelGlasgow Coma Score-EyeGlasgow Coma Score-VerbalGlasgow Coma Score-MotorGlasgow Coma Score-QualifierTotal Glasgow Coma ScoreTemperatureTemperature MethodLevel of ResponsivenessPain ScaleSCData Element(Red NEMSIS National EMS Database Elements)NationalDatabaseSouth Carolina State EMS DatasetXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXPage 5 of 9

E14 24E14 25E14 26E14 27E14 28E15 01E15 02E15 03E15 04E15 05E15 06E15 07E15 08E15 09E15 10E15 11E16 01E16 02E16 03E16 04E16 05E16 06E16 07E16 08E16 09E16 10E16 11E16 12E16 13E16 14E16 15E16 16E16 17E16 18E16 19E16 20E16 21E16 22E16 23Stroke ScaleThrombolytic ScreenAPGARRevised Trauma ScorePediatric Trauma ScoreNHTSA Injury Matrix External/SkinNHTSA Injury Matrix HeadNHTSA Injury Matrix FaceNHTSA Injury Matrix NeckNHTSA Injury Matrix ThoraxNHTSA Injury Matrix AbdomenNHTSA Injury Matrix SpineNHTSA Injury Matrix Upper ExtremitiesNHTSA Injury Matrix PelvisNHTSA Injury Matrix Lower ExtremitiesNHTSA Injury Matrix UnspecifiedEstimated Body WeightBroselow/Luten ColorDate/Time of AssessmentSkin AssessmentHead/Face AssessmentNeck AssessmentChest/Lungs AssessmentHeart AssessmentAbdomen Left Upper AssessmentAbdomen Left Lower AssessmentAbdomen Right Upper AssessmentAbdomen Right Lower AssessmentGU AssessmentBack Cervical AssessmentBack Thoracic AssessmentBack Lumbar/Sacral AssessmentExtremities-Right Upper AssessmentExtremities-Right Lower AssessmentExtremities-Left Upper AssessmentExtremities-Left Lower AssessmentEyes-Left AssessmentEyes-Right AssessmentMental Status AssessmentSCData Element(Red NEMSIS National EMS Database Elements)NationalDatabaseSouth Carolina State EMS DatasetXXXXXXXXXXXXXXXXXXXXXXXXXXPage 6 of 9

E16 24E17 01E18 01E18 02E18 03E18 04E18 05E18 06E18 07E18 08E18 09E18 10E18 11E19 01E19 02E19 03E19 04E19 05E19 06E19 07E19 08E19 09E19 10E19 11E19 12E19 13E19 14E20 01E20 02E20 03E20 04E20 05E20 06E20 07E20 08E20 09E20 10E20 11E20 12Neurological AssessmentProtocols UsedDate/Time Medication AdministeredMedication Administered Prior to this Units EMS CareMedication GivenMedication Administered RouteMedication DosageMedication Dosage UnitsResponse to MedicationMedication ComplicationMedication Crew Member IDMedication AuthorizationMedication Authorizing PhysicianDate/Time Procedure Performed SuccessfullyProcedure Performed Prior to this Units EMS CareProcedureSize of Procedure EquipmentNumber of Procedure AttemptsProcedure SuccessfulProcedure ComplicationResponse to ProcedureProcedure Crew Members IDProcedure AuthorizationProcedure Authorizing PhysicianSuccessful IV SiteTube ConfirmationDestination Confirmation of Tube PlacementDestination/Transferred To, NameDestination/Transferred To, CodeDestination Street AddressDestination CityDestination StateDestination CountyDestination Zip CodeDestination GPS LocationDestination Zone NumberIncident/Patient DispositionHow Patient Was Moved to AmbulancePosition of Patient During Transport SCData Element(Red NEMSIS National EMS Database Elements)NationalDatabaseSouth Carolina State EMS DatasetXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXPage 7 of 9

E20 13E20 14E20 15E20 16E20 17E21 01E21 02E21 03E21 04E21 05E21 06E21 07E21 08E21 09E21 10E21 11E21 12E21 13E21 14E21 15E21 16E21 17E21 18E21 19E21 20E22 01E22 02E22 03E22 04E22 05E22 06E23 01E23 02E23 03E23 04E23 05E23 06E23 07E23 08How Patient Was Transported From AmbulanceTransport Mode from SceneCondition of Patient at DestinationReason for Choosing DestinationType of DestinationEvent Date/TimeMedical Device Event NameWaveform Graphic TypeWaveform GraphicAED, Pacing, or CO2 ModeECG LeadECG InterpretationType of ShockShock or Pacing EnergyTotal Number of Shocks DeliveredPacing RateDevice Heart RateDevice Pulse RateDevice Systolic Blood PressureDevice Diastolic Blood PressureDevice Respiratory RateDevice Pulse OximetryDevice CO2 or etCO2Device CO2, etCO2, or Invasive Pressure Monitor UnitsDevice Invasive Pressure MeanEmergency Department DispositionHospital DispositionLaw Enforcement/Crash Report NumberTrauma Registry IDFire Incident Report NumberPatient ID Band/Tag NumberReview RequestedPotential Registry CandidatePersonal Protective Equipment UsedSuspected Intentional, or Unintentional DisasterSuspected Contact with Blood/Body Fluids, EMS Injury/DeathType of Suspected Blood/Body Fluid Exposure, Injury, or DeathPersonnel ExposedRequired Reportable Conditions SCData Element(Red NEMSIS National EMS Database Elements)NationalDatabaseSouth Carolina State EMS DatasetXXXXXXXXXXXX XXXXXXXXXXPage 8 of 9