NEMSIS Data Elements and Values v2.2.1.1.2009 002

Number D01_03 D01_04 D01_05 D01_05 D01_05 D01_05 D01_05 D01_05 D01_05 D01_05 D01_06 D01_06 D01_06 D01_06
D01_06 D01_06 D01_06 D01_06 D01_06 D01_06 D01_06 D01_07 D01_07 D01_07 D01_07 D01_07 D01_07 D01_08 D01_08 D01_08 D01_08 D01_08 D01_08 D01_09 D01_09 D01_09 D01_11 D01_11 D01_11 D01_19 D01_19 D01_19 D01_19 D01_19 D01_19 D01_19 D01_19 D01_20 D01_20 D01_21 D01_21
Data Element EMS Agency State EMS Agency County Primary Type of Service Primary Type of Service Primary Type of Service Primary Type of Service Primary Type of Service Primary Type of Service Primary Type of Service Primary Type of Service Other Types of Service Other Types of Service Other Types of Service Other Types of Service Other Types of Service Other Types of Service Other Types of Service Other Types of Service Other Types of Service Other Types of Service Other Types of Service Level of Service Level of Service Level of Service Level of Service Level of Service Level of Service Organizational Type Organizational Type Organizational Type Organizational Type Organizational Type Organizational Type Organization Status Organization Status Organization Status Other Agencies In Area Other Agencies In Area Other Agencies In Area EMS Agency Time Zone EMS Agency Time Zone EMS Agency Time Zone EMS Agency Time Zone EMS Agency Time Zone EMS Agency Time Zone EMS Agency Time Zone EMS Agency Time Zone EMS Agency Daylight Savings Time Use EMS Agency Daylight Savings Time Use National Provider Identifier National Provider Identifier
Variable Code 10002 10003 5610 5620 5630 5640 5650 5660 5670 5680 -25 -10 -5 5690 5700 5710 5720 5730 5740 5750 5760 6090 6100 6110 6111 6112 6120 5810 5820 5830 5840 5850 5860 5870 5880 5890 -25 -10 -5 5900 5910 5920 5930 5940 5950 5960 5970 0 1 -25 -15
D01_21 D01_21 D02_02 D02_02 D02_02 D02_03 D02_03 D02_03 D02_04 D02_04 D02_04 D02_05 D02_05 D02_05 D02_06 D02_06 D02_06 D02_08 D02_08 D02_08 D02_09 D02_09 D02_09 D02_10 D02_10 D02_10 D02_11 D02_11 D02_11 D03_02 D03_02 D03_02 D03_03 D03_03 D03_03 D03_04 D03_04 D03_04 D03_05 D03_05 D03_05 D03_06 D03_06 D03_06 D03_08 D03_08 D03_08 D03_09 D03_09 D03_09 D03_10 D03_10
National Provider Identifier National Provider Identifier Agency Contact Middle Name/Initial Agency Contact Middle Name/Initial Agency Contact Middle Name/Initial Agency Contact First Name Agency Contact First Name Agency Contact First Name Agency Contact Address Agency Contact Address Agency Contact Address Agency Contact City Agency Contact City Agency Contact City Agency Contact State Agency Contact State Agency Contact State Agency Contact Telephone Number Agency Contact Telephone Number Agency Contact Telephone Number Agency Contact Fax Number Agency Contact Fax Number Agency Contact Fax Number Agency Contact Email Address Agency Contact Email Address Agency Contact Email Address Agency Contact Web Address Agency Contact Web Address Agency Contact Web Address Agency Medical Director Middle Name/Initial Agency Medical Director Middle Name/Initial Agency Medical Director Middle Name/Initial Agency Medical Director First Name Agency Medical Director First Name Agency Medical Director First Name Agency Medical Director Address Agency Medical Director Address Agency Medical Director Address Agency Medical Director City Agency Medical Director City Agency Medical Director City Agency Medical Director State Agency Medical Director State Agency Medical Director State Agency Medical Director Telephone Number Agency Medical Director Telephone Number Agency Medical Director Telephone Number Agency Medical Director Fax Number Agency Medical Director Fax Number Agency Medical Director Fax Number Agency Medical Director's Medical Specialty Agency Medical Director's Medical Specialty
-10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10
Agency Medical Director's Medical Specialty Agency Medical Director's Medical Specialty Agency Medical Director's Medical Specialty Agency Medical Director's Medical Specialty Agency Medical Director's Medical Specialty Agency Medical Director's Medical Specialty Agency Medical Director's Medical Specialty Agency Medical Director's Medical Specialty Agency Medical Director's Medical Specialty Agency Medical Director's Medical Specialty Agency Medical Director's Medical Specialty Agency Medical Director's Medical Specialty Agency Medical Director Email Address Agency Medical Director Email Address Agency Medical Director Email Address State Certification Licensure Levels State Certification Licensure Levels State Certification Licensure Levels State Certification Licensure Levels State Certification Licensure Levels State Certification Licensure Levels Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures
-5 5980 5990 6000 6010 6020 6030 6040 6050 6060 6070 6080 -25 -10 -5 6090 6100 6110 6111 6112 6120 1.181 1.182 31.110 31.120 31.420 31.421 34.041 34.042 37.000 37.611 37.612 38.910 38.990 38.991 38.992 38.993 38.994 38.995 39.995 39.996 39.997 39.998 41.920 41.921 57.940 73.590 79.700 86.090 86.280 89.391 89.392
Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures
89.510 89.590 89.599 89.610 89.620 89.640 89.700 89.701 89.702 89.703 89.704 89.820 89.821 93.055 93.056 93.057 93.058 93.059 93.350 93.450 93.540 93.580 93.591 93.900 93.910 93.930 93.931 93.940 96.010 96.020 96.030 96.040 96.041 96.042 96.051 96.052 96.053 96.070 96.071 96.700 96.701 96.702 96.703 96.790 96.991 96.992 96.993 97.230 97.231 98.130 98.131 98.150
Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Procedures Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol
99.640 99.641 99.841 99.842 99.810 99.811 99.290 99.624 99.626 99.623 99.601 99.602 99.603 99.604 99.600 99.611 99.612 99.615 99.621 99.622 99.625 100.100 100.200 100.301 100.302 100.303 101.101 101.102 101.103 101.104 101.105 101.201 101.202 101.203 101.204 101.205 101.206 100.300 101.500 6720 6730 6740 6760 6770 6780 6785 6790 6791 6800 6810 6820 6830
Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol Protocol
6840 6850 6860 6870 6875 6880 6881 6885 6890 6892 6900 6910 6911 6912 6913 6914 6915 6916 6917 6920 6925 6930 6935 6940 6945 6950 6960 6965 6970 6980 6990 7000 7010 7020 7030 7040 7130 7140 7150 7160 7170 7175 7180 7190 7200 7210 7214 7215 7220 7230 7232 7240
Protocol Personnel Level Permitted to Use the Protocol Personnel Level Permitted to Use the Protocol Personnel Level Permitted to Use the Protocol Personnel Level Permitted to Use the Protocol Personnel Level Permitted to Use the Protocol Personnel Level Permitted to Use the Protocol Billing Status Billing Status Hospital Facility Number Hospital Facility Number Hospital Facility Number Destination Facility Number Destination Facility Number Destination Facility Number Destination Type Destination Type Destination Type Destination Type Destination Type Destination Type Destination Type Destination Type Destination Type Station Number Station Number Station Number Station Address Station Address Station Address Station City Station City Station City Station State Station State Station State Station Telephone Number Station Telephone Number Station Telephone Number Vehicle Type Vehicle Type Vehicle Type Vehicle Type Vehicle Type Vehicle Type Vehicle Type Vehicle Type Vehicle Type Vehicle Type Vehicle Type Vehicle Type State Certification/Licensure Levels
7251 6090 6100 6110 6111 6112 6120 0 1 -25 -10 -5 -25 -10 -5 7270 7280 7290 7300 7320 7330 7340 7350 7360 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 7370 7380 7390 7400 7410 7420 7430 7440 7450 7460 7470 7480 6090
State Certification/Licensure Levels State Certification/Licensure Levels State Certification/Licensure Levels State Certification/Licensure Levels State Certification/Licensure Levels Annual Vehicle Hours Annual Vehicle Hours Annual Vehicle Hours Annual Vehicle Miles Annual Vehicle Miles Annual Vehicle Miles Personnel's Employment Status Personnel's Employment Status Personnel's Employment Status Personnel's Employment Status Personnel's Employment Status Personnel's Level of Certification/Licensure for Agency Personnel's Level of Certification/Licensure for Agency Personnel's Level of Certification/Licensure for Agency Personnel's Level of Certification/Licensure for Agency Personnel's Level of Certification/Licensure for Agency Personnel's Level of Certification/Licensure for Agency Personnel's Level of Certification/Licensure for Agency EMS Personnel's Middle Name/Initial EMS Personnel's Middle Name/Initial EMS Personnel's Middle Name/Initial EMS Personnel's First Name EMS Personnel's First Name EMS Personnel's First Name EMS Personnel's Mailing Address EMS Personnel's Mailing Address EMS Personnel's Mailing Address EMS Personnel's City of Residence EMS Personnel's City of Residence EMS Personnel's City of Residence EMS Personnel's State EMS Personnel's State EMS Personnel's State EMS Personnel's Work Telephone EMS Personnel's Work Telephone EMS Personnel's Work Telephone EMS Personnel's Home Telephone EMS Personnel's Home Telephone EMS Personnel's Home Telephone EMS Personnel's Email Address EMS Personnel's Email Address EMS Personnel's Email Address EMS Personnel's Gender EMS Personnel's Gender EMS Personnel's Gender EMS Personnel's Gender EMS Personnel's Gender
6100 6110 6111 6112 6120 -25 -10 -5 -25 -10 -5 7490 7500 7510 7520 7530 6090 6100 6110 6111 6112 6120 10007 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 -25 -10 -5 650 655
D08_13 D08_13 D08_13 D08_13 D08_13 D08_13 D08_14 D08_14 D08_15 D08_15 D08_15 D08_15 D08_15 D08_15 D08_15 D08_16 D08_16 D08_16 D08_16 D08_16 E00 E00 E00 E00 E00 E02_02 E02_02 E02_02 E02_02 E02_03 E02_03 E02_03 E02_03 E02_04 E02_04 E02_04 E02_04 E02_04 E02_04 E02_05 E02_05 E02_05 E02_05 E02_06 E02_06 E02_06 E02_06 E02_06 E02_06 E02_06 E02_06 E02_06
EMS Personnel's Race EMS Personnel's Race EMS Personnel's Race EMS Personnel's Race EMS Personnel's Race EMS Personnel's Race EMS Personnel's Ethnicity EMS Personnel's Ethnicity State EMS Certification Licensure Level State EMS Certification Licensure Level State EMS Certification Licensure Level State EMS Certification Licensure Level State EMS Certification Licensure Level State EMS Certification Licensure Level State EMS Certification Licensure Level National Registry Credentialed National Registry Credentialed National Registry Credentialed National Registry Credentialed National Registry Credentialed Common Null Values Common Null Values Common Null Values Common Null Values Common Null Values Incident Number Incident Number Incident Number Incident Number EMS Unit (Vehicle) Response Number EMS Unit (Vehicle) Response Number EMS Unit (Vehicle) Response Number EMS Unit (Vehicle) Response Number Type of Service Requested Type of Service Requested Type of Service Requested Type of Service Requested Type of Service Requested Type of Service Requested Primary Role of the Unit Primary Role of the Unit Primary Role of the Unit Primary Role of the Unit Type of Dispatch Delay Type of Dispatch Delay Type of Dispatch Delay Type of Dispatch Delay Type of Dispatch Delay Type of Dispatch Delay Type of Dispatch Delay Type of Dispatch Delay Type of Dispatch Delay
660 665 670 675 680 685 690 695 6090 6100 6110 6111 6112 6120 10007 -25 -10 -5 0 1 -25 -20 -15 -10 -5 -25 -10 -5 10001 -25 -10 -5 10001 30 35 40 45 50 55 60 65 70 75 -25 -15 -10 -5 80 85 90 95 100
E02_06 E02_06 E02_06 E02_06 E02_07 E02_07 E02_07 E02_07 E02_07 E02_07 E02_07 E02_07 E02_07 E02_07 E02_07 E02_07 E02_07 E02_07 E02_07 E02_07 E02_07 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_08 E02_09 E02_09 E02_09 E02_09 E02_09 E02_09 E02_09 E02_09 E02_09 E02_09 E02_09 E02_09
Type of Dispatch Delay Type of Dispatch Delay Type of Dispatch Delay Type of Dispatch Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Response Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Scene Delay Type of Transport Delay Type of Transport Delay Type of Transport Delay Type of Transport Delay Type of Transport Delay Type of Transport Delay Type of Transport Delay Type of Transport Delay Type of Transport Delay Type of Transport Delay Type of Transport Delay Type of Transport Delay
105 110 115 120 -25 -15 -10 -5 125 130 135 140 145 150 155 160 165 170 175 180 185 -25 -15 -10 -5 190 195 200 205 210 215 220 225 230 235 240 245 250 255 260 -25 -15 -10 -5 265 270 275 280 285 290 295 300
Type of Transport Delay Type of Transport Delay Type of Transport Delay Type of Transport Delay Type of Transport Delay Type of Turn-Around Delay Type of Turn-Around Delay Type of Turn-Around Delay Type of Turn-Around Delay Type of Turn-Around Delay Type of Turn-Around Delay Type of Turn-Around Delay Type of Turn-Around Delay Type of Turn-Around Delay Type of Turn-Around Delay Type of Turn-Around Delay Type of Turn-Around Delay Type of Turn-Around Delay Type of Turn-Around Delay EMS Unit/Vehicle Number EMS Unit/Vehicle Number EMS Unit/Vehicle Number EMS Unit/Vehicle Number EMS Unit Call Sign (Radio Number) Vehicle Dispatch Location Vehicle Dispatch Location Vehicle Dispatch Location Vehicle Dispatch Location Vehicle Dispatch Zone Vehicle Dispatch Zone Vehicle Dispatch Zone Vehicle Dispatch Zone Vehicle Dispatch GPS Location Beginning Odometer Reading of Responding Vehicle On-Scene Odometer Reading of Responding Vehicle Patient Destination Odometer Reading of Responding Vehicle Ending Odometer Reading of Responding Vehicle Response Mode to Scene Response Mode to Scene Response Mode to Scene Response Mode to Scene Complaint Reported by Dispatch Complaint Reported by Dispatch Complaint Reported by Dispatch Complaint Reported by Dispatch Complaint Reported by Dispatch Complaint Reported by Dispatch Complaint Reported by Dispatch Complaint Reported by Dispatch Complaint Reported by Dispatch Complaint Reported by Dispatch Complaint Reported by Dispatch
305 310 315 320 325 -25 -15 -10 -5 330 335 340 345 350 355 360 365 370 375 -25 -10 -5 10001 10001 -25 -10 -5 10001 -25 -10 -5 10001 10001 10001 10001 10001 10001 380 385 390 395 -25 -15 -10 -5 400 405 410 415 420 425 430
E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_01 E03_02 E03_02 E03_02 E03_02 E03_02 E03_02 E03_02 E03_03 E03_03 E03_03 E03_03 E04_01 E04_01 E04_01 E04_01 E04_02 E04_02 E04_02 E04_02 E04_02 E04_02 E04_02 E04_02 E04_03
Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported Complaint Reported EMD Performed EMD Performed EMD Performed EMD Performed EMD Performed EMD Performed EMD Performed EMD Card Number EMD Card Number EMD Card Number EMD Card Number Crew Member ID Crew Member ID Crew Member ID Crew Member ID Crew Member Role Crew Member Role Crew Member Role Crew Member Role Crew Member Role Crew Member Role Crew Member Role Crew Member Role Crew Member Level
by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch by Dispatch
435 440 445 450 455 460 465 470 475 480 485 490 495 500 505 510 515 520 525 530 535 540 545 550 555 560 565 -25 -15 -10 -5 0 570 575 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 580 585 590 595 600 -25
Crew Member Level Crew Member Level Crew Member Level Crew Member Level Crew Member Level Crew Member Level Crew Member Level Crew Member Level Crew Member Level Crew Member Level Crew Member Level Incident or Onset Date/Time PSAP Call Date/Time Dispatch Notified Date/Time Unit Notified by Dispatch Date/Time Unit En Route Date/Time Unit Arrived on Scene Date/Time Arrived at Patient Date/Time Transfer of Patient Care Date/Time Unit Left Scene Date/Time Patient Arrived at Destination Date/Time Unit Back in Service Date/Time Unit Cancelled Date/Time Unit Back at Home Location Date/Time Last Name Last Name Last Name Last Name First Name First Name First Name First Name Middle Initial/Name Middle Initial/Name Middle Initial/Name Middle Initial/Name Patient's Home Address Patient's Home Address Patient's Home Address Patient's Home Address Patient's Home City Patient's Home City Patient's Home City Patient's Home City Patient's Home County Patient's Home County Patient's Home County Patient's Home County Patient's Home State Patient's Home State Patient's Home State Patient's Home State
-10 -5 635 640 645 6090 6100 6110 6111 6112 6120 10001 10001 10001 10001 10001 10001 10001 10001 10001 10001 10001 10001 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001
Patient's Home Zip Code Patient's Home Zip Code Patient's Home Zip Code Patient's Home Zip Code Patient's Home Zip Code Patients Home Country Patients Home Country Patients Home Country Patients Home Country Social Security Number Social Security Number Social Security Number Social Security Number Gender Gender Gender Gender Gender Gender Race Race Race Race Race Race Race Race Race Race Ethnicity Ethnicity Ethnicity Ethnicity Ethnicity Ethnicity Age Age Units Age Units Age Units Age Units Age Units Age Units Age Units Age Units Date of Birth Primary or Home Telephone Number Primary or Home Telephone Number Primary or Home Telephone Number Primary or Home Telephone Number State Issuing Driver's License State Issuing Driver's License State Issuing Driver's License
-25 -15 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -15 -10 -5 650 655 -25 -15 -10 -5 660 665 670 675 680 685 -25 -15 -10 -5 690 695 10001 -25 -15 -10 -5 700 705 710 715 10001 -25 -10 -5 10001 -25 -10 -5
State Issuing Driver's License Driver's License Number Driver's License Number Driver's License Number Driver's License Number Primary Method of Payment Primary Method of Payment Primary Method of Payment Primary Method of Payment Primary Method of Payment Primary Method of Payment Primary Method of Payment Primary Method of Payment Primary Method of Payment Primary Method of Payment Certificate of Medical Necessity Certificate of Medical Necessity Certificate of Medical Necessity Certificate of Medical Necessity Certificate of Medical Necessity Insurance Company ID/Name Insurance Company ID/Name Insurance Company ID/Name Insurance Company ID/Name Insurance Company Billing Priority Insurance Company Billing Priority Insurance Company Billing Priority Insurance Company Billing Priority Insurance Company Billing Priority Insurance Company Billing Priority Insurance Company Address Insurance Company Address Insurance Company Address Insurance Company Address Insurance Company City Insurance Company City Insurance Company City Insurance Company City Insurance Company State Insurance Company State Insurance Company State Insurance Company State Insurance Company Zip Code Insurance Company Zip Code Insurance Company Zip Code Insurance Company Zip Code Insurance Group ID/Name Insurance Group ID/Name Insurance Group ID/Name Insurance Group ID/Name Insurance Policy ID Number Insurance Policy ID Number
10001 -25 -10 -5 10001 -25 -10 -5 720 725 730 735 740 745 750 -25 -10 -5 0 1 -25 -10 -5 10001 -25 -10 -5 755 760 765 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10
Insurance Policy ID Number Insurance Policy ID Number Last Name of the Insured Last Name of the Insured Last Name of the Insured Last Name of the Insured Last Name of the Insured First Name of the Insured First Name of the Insured First Name of the Insured First Name of the Insured Middle Initial/Name of the Insured Middle Initial/Name of the Insured Middle Initial/Name of the Insured Middle Initial/Name of the Insured Relationship to the Insured Relationship to the Insured Relationship to the Insured Relationship to the Insured Relationship to the Insured Relationship to the Insured Relationship to the Insured Work-Related Work-Related Work-Related Work-Related Work-Related Patients Occupational Industry Patients Occupational Industry Patients Occupational Industry Patients Occupational Industry Patients Occupational Industry Patients Occupational Industry Patients Occupational Industry Patients Occupational Industry Patients Occupational Industry Patients Occupational Industry Patients Occupational Industry Patients Occupational Industry Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation
-5 10001 -25 -15 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 770 775 780 785 -25 -10 -5 0 1 -25 -10 -5 790 795 800 805 810 815 820 825 830 -25 -10 -5 835 840 845 850 855 860 865 870 875 880
Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Patients Occupation Closest Relative/Guardian Last Name Closest Relative/Guardian Last Name Closest Relative/Guardian Last Name Closest Relative/Guardian Last Name First Name of the Closest Relative/ Guardian First Name of the Closest Relative/ Guardian First Name of the Closest Relative/ Guardian First Name of the Closest Relative/ Guardian Middle Initial/Name of the Closest Relative/ Guardian Middle Initial/Name of the Closest Relative/ Guardian Middle Initial/Name of the Closest Relative/ Guardian Middle Initial/Name of the Closest Relative/ Guardian Closest Relative/ Guardian Street Address Closest Relative/ Guardian Street Address Closest Relative/ Guardian Street Address Closest Relative/ Guardian Street Address Closest Relative/ Guardian City Closest Relative/ Guardian City Closest Relative/ Guardian City Closest Relative/ Guardian City Closest Relative/ Guardian State Closest Relative/ Guardian State Closest Relative/ Guardian State Closest Relative/ Guardian State Closest Relative/ Guardian Zip Code Closest Relative/ Guardian Zip Code Closest Relative/ Guardian Zip Code Closest Relative/ Guardian Zip Code Closest Relative/ Guardian Phone Number Closest Relative/ Guardian Phone Number Closest Relative/ Guardian Phone Number Closest Relative/ Guardian Phone Number Closest Relative/ Guardian Relationship Closest Relative/ Guardian Relationship Closest Relative/ Guardian Relationship Closest Relative/ Guardian Relationship Closest Relative/ Guardian Relationship Closest Relative/ Guardian Relationship Closest Relative/ Guardian Relationship
885 890 895 900 905 910 915 920 925 930 935 940 945 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 950 955 960 965
Closest Relative/ Guardian Relationship Closest Relative/ Guardian Relationship Patient's Employer Patient's Employer Patient's Employer Patient's Employer Patient's Employer's Address Patient's Employer's Address Patient's Employer's Address Patient's Employer's Address Patients Employers City Patients Employers City Patients Employers City Patients Employers City Patients Employers State Patients Employers State Patients Employers State Patients Employers State Patients Employers Zip Code Patients Employers Zip Code Patients Employers Zip Code Patients Employers Zip Code Patient's Work Telephone Number Patient's Work Telephone Number Patient's Work Telephone Number Patient's Work Telephone Number Response Urgency Response Urgency Response Urgency Response Urgency Response Urgency CMS Service Level CMS Service Level CMS Service Level CMS Service Level CMS Service Level CMS Service Level CMS Service Level CMS Service Level CMS Service Level CMS Service Level CMS Service Level CMS Service Level CMS Service Level Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number
970 975 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 980 985 -25 -15 -10 -5 990 995 1000 1005 1010 1015 1020 1025 1030 -25 -15 -10 -5 8001 8002 8003 8004
Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number
8005 8006 8007 8008 8009 8010 8011 8012 8013 8014 8015 8016 8017 8018 8019 8020 8021 8022 8023 8024 8025 8026 8027 8028 8029 8030 8031 8032 8033 8034 8035 8036 8037 8038 8039 8040 8041 8042 8043 8044 8045 8046 8047 8048 8049 8050 8051 8052 8053 8054 8055 8056
Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number Condition Code Number ICD-9 Code for the Condition Code Number ICD-9 Code for the Condition Code Number ICD-9 Code for the Condition Code Number ICD-9 Code for the Condition Code Number Condition Code Modifier Condition Code Modifier Condition Code Modifier Condition Code Modifier Condition Code Modifier Condition Code Modifier Condition Code Modifier Condition Code Modifier Condition Code Modifier Condition Code Modifier Condition Code Modifier Condition Code Modifier Condition Code Modifier Other EMS Agencies at Scene Other EMS Agencies at Scene Other EMS Agencies at Scene Other EMS Agencies at Scene Other Services at Scene Other Services at Scene Other Services at Scene Other Services at Scene Other Services at Scene Other Services at Scene Other Services at Scene Other Services at Scene Other Services at Scene Other Services at Scene Other Services at Scene Estimated Date/Time Initial Responder Arrived on Scene Estimated Date/Time Initial Responder Arrived on Scene
8057 8058 8059 8060 8061 8062 8063 8064 8065 8066 8067 8068 8069 8070 8071 8072 8073 8074 -25 -10 -5 10001 -25 -10 -5 1035 1036 1037 1038 1039 1040 1041 1042 1043 1044 -25 -10 -5 10001 -25 -10 -5 1060 1065 1070 1075 1080 1085 1090 1095 -25 -10
Estimated Date/Time Initial Responder Arrived on Scene Estimated Date/Time Initial Responder Arrived on Scene Estimated Date/Time Initial Responder Arrived on Scene Estimated Date/Time Initial Responder Arrived on Scene Estimated Date/Time Initial Responder Arrived on Scene Date/Time Initial Responder Arrived on Scene Number of Patients at Scene Number of Patients at Scene Number of Patients at Scene Number of Patients at Scene Number of Patients at Scene Number of Patients at Scene Number of Patients at Scene Mass Casualty Incident Mass Casualty Incident Mass Casualty Incident Mass Casualty Incident Mass Casualty Incident Mass Casualty Incident Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Location Type Incident Facility Code Incident Facility Code Incident Facility Code Incident Facility Code Scene Zone Number Scene Zone Number Scene Zone Number Scene Zone Number Scene GPS Location Incident Address Incident Address Incident Address Incident Address Incident City Incident City Incident City Incident City
-5 1100 1105 1110 1115 10001 -25 -15 -10 -5 1120 1125 1130 -25 -15 -10 -5 0 1 -25 -15 -10 -5 1135 1140 1145 1150 1155 1160 1165 1170 1175 1180 1185 1190 -25 -10 -5 10001 -25 -10 -5 10001 10001 -25 -10 -5 10001 -25 -10 -5 10001
Incident County Incident County Incident County Incident County Incident State Incident State Incident State Incident State Incident ZIP Code Incident ZIP Code Incident ZIP Code Incident ZIP Code Incident ZIP Code Prior Aid Prior Aid Prior Aid Prior Aid Prior Aid Prior Aid Performed by Prior Aid Performed by Prior Aid Performed by Prior Aid Performed by Prior Aid Performed by Prior Aid Performed by Prior Aid Performed by Prior Aid Performed by Prior Aid Performed by Outcome of the Prior Aid Outcome of the Prior Aid Outcome of the Prior Aid Outcome of the Prior Aid Outcome of the Prior Aid Outcome of the Prior Aid Outcome of the Prior Aid Possible Injury Possible Injury Possible Injury Possible Injury Possible Injury Possible Injury Chief Complaint Chief Complaint Chief Complaint Chief Complaint Duration of Chief Complaint Time Units of Duration of Chief Complaint Time Units of Duration of Chief Complaint Time Units of Duration of Chief Complaint Time Units of Duration of Chief Complaint Time Units of Duration of Chief Complaint Time Units of Duration of Chief Complaint Time Units of Duration of Chief Complaint
-25 -10 -5 10001 -25 -10 -5 10001 -25 -15 -10 -5 10001 -25 -15 -10 -5 10001 -25 -15 -10 -5 1195 1200 1205 1210 1215 -25 -15 -10 -5 1220 1225 1230 -25 -15 -10 -5 0 1 -25 -10 -5 10001 10001 1235 1240 1245 1250 1255 1260 1265
Time Units of Duration of Chief Complaint Secondary Complaint Narrative Secondary Complaint Narrative Secondary Complaint Narrative Secondary Complaint Narrative Duration of Secondary Complaint Time Units of Duration of Secondary Complaint Time Units of Duration of Secondary Complaint Time Units of Duration of Secondary Complaint Time Units of Duration of Secondary Complaint Time Units of Duration of Secondary Complaint Time Units of Duration of Secondary Complaint Time Units of Duration of Secondary Complaint Chief Complaint Anatomic Location Chief Complaint Anatomic Location Chief Complaint Anatomic Location Chief Complaint Anatomic Location Chief Complaint Anatomic Location Chief Complaint Anatomic Location Chief Complaint Anatomic Location Chief Complaint Anatomic Location Chief Complaint Anatomic Location Chief Complaint Anatomic Location Chief Complaint Anatomic Location Chief Complaint Anatomic Location Chief Complaint Anatomic Location Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Chief Complaint Organ System Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom
10001 -25 -10 -5 10001 10001 1270 1275 1280 1285 1290 1295 1300 -25 -15 -10 -5 1305 1310 1315 1320 1325 1330 1335 1340 1345 -25 -15 -10 -5 1350 1355 1360 1365 1370 1375 1380 1385 1390 1395 1400 -25 -15 -10 -5 1405 1410 1415 1420 1425 1430 1435
Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Primary Symptom Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Other Associated Symptoms Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression
1440 1445 1450 1455 1460 1465 1470 1475 1480 1485 1490 1495 1500 1505 -25 -15 -10 -5 1510 1515 1520 1525 1530 1535 1540 1545 1550 1555 1560 1565 1570 1575 1580 1585 1590 1595 1600 1605 1610 -25 -15 -10 -5 1615 1620 1625 1630 1635 1640 1645 1650 1655
Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Primary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Providers Secondary Impression Cause of Injury Cause of Injury Cause of Injury
1660 1665 1670 1675 1680 1685 1690 1695 1700 1705 1710 1715 1720 1725 1730 1735 1740 1745 -25 -15 -10 -5 1750 1755 1760 1765 1770 1775 1780 1785 1790 1795 1800 1805 1810 1815 1820 1825 1830 1835 1840 1845 1850 1855 1860 1865 1870 1875 1880 -25 -15 -10
Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Cause of Injury Intent of the Injury Intent of the Injury Intent of the Injury Intent of the Injury Intent of the Injury Intent of the Injury Mechanism of Injury Mechanism of Injury Mechanism of Injury Mechanism of Injury Mechanism of Injury Mechanism of Injury Mechanism of Injury Vehicular Injury Indicators Vehicular Injury Indicators Vehicular Injury Indicators Vehicular Injury Indicators Vehicular Injury Indicators Vehicular Injury Indicators Vehicular Injury Indicators
-5 9500 9505 9510 9515 9520 9525 9530 9535 9540 9545 9550 9555 9560 9565 9570 9575 9580 9585 9590 9595 9600 9605 9610 9615 9620 9625 9630 9635 9640 9645 9650 -25 -10 -5 2020 2025 2030 -25 -10 -5 2035 2040 2045 2050 -25 -10 -5 2055 2060 2065 2070
Vehicular Injury Indicators Vehicular Injury Indicators Vehicular Injury Indicators Vehicular Injury Indicators Vehicular Injury Indicators Area of the Vehicle impacted by the collision Area of the Vehicle impacted by the collision Area of the Vehicle impacted by the collision Area of the Vehicle impacted by the collision Area of the Vehicle impacted by the collision Area of the Vehicle impacted by the collision Area of the Vehicle impacted by the collision Area of the Vehicle impacted by the collision Area of the Vehicle impacted by the collision Area of the Vehicle impacted by the collision Area of the Vehicle impacted by the collision Area of the Vehicle impacted by the collision Seat Row Location of Patient in Vehicle Seat Row Location of Patient in Vehicle Position of Patient in the Seat of the Vehicle Position of Patient in the Seat of the Vehicle Position of Patient in the Seat of the Vehicle Position of Patient in the Seat of the Vehicle Position of Patient in the Seat of the Vehicle Position of Patient in the Seat of the Vehicle Position of Patient in the Seat of the Vehicle Position of Patient in the Seat of the Vehicle Use of Occupant Safety Equipment Use of Occupant Safety Equipment Use of Occupant Safety Equipment Use of Occupant Safety Equipment Use of Occupant Safety Equipment Use of Occupant Safety Equipment Use of Occupant Safety Equipment Use of Occupant Safety Equipment Use of Occupant Safety Equipment Use of Occupant Safety Equipment Use of Occupant Safety Equipment Use of Occupant Safety Equipment Use of Occupant Safety Equipment Airbag Deployment Airbag Deployment Airbag Deployment Airbag Deployment Airbag Deployment Airbag Deployment Airbag Deployment Airbag Deployment Height of Fall Cardiac Arrest Cardiac Arrest Cardiac Arrest
2075 2080 2085 2090 2095 -25 -10 -5 2100 2105 2110 2115 2120 2125 2130 2135 2140 10001 18033 -25 -10 -5 2145 2150 2155 2160 2165 -25 -10 -5 2170 2175 2180 2185 2187 2190 2195 2200 2205 2210 -25 -10 -5 2215 2220 2225 2230 2235 10001 -25 -15 -10
Cardiac Arrest Cardiac Arrest Cardiac Arrest Cardiac Arrest Cardiac Arrest Etiology Cardiac Arrest Etiology Cardiac Arrest Etiology Cardiac Arrest Etiology Cardiac Arrest Etiology Cardiac Arrest Etiology Cardiac Arrest Etiology Cardiac Arrest Etiology Cardiac Arrest Etiology Cardiac Arrest Etiology Resuscitation Attempted Resuscitation Attempted Resuscitation Attempted Resuscitation Attempted Resuscitation Attempted Resuscitation Attempted Resuscitation Attempted Resuscitation Attempted Resuscitation Attempted Resuscitation Attempted Arrest Witnessed by Arrest Witnessed by Arrest Witnessed by Arrest Witnessed by Arrest Witnessed by Arrest Witnessed by First Monitored Rhythm of the Patient First Monitored Rhythm of the Patient First Monitored Rhythm of the Patient First Monitored Rhythm of the Patient First Monitored Rhythm of the Patient First Monitored Rhythm of the Patient First Monitored Rhythm of the Patient First Monitored Rhythm of the Patient First Monitored Rhythm of the Patient First Monitored Rhythm of the Patient First Monitored Rhythm of the Patient First Monitored Rhythm of the Patient Any Return of Spontaneous Circulation Any Return of Spontaneous Circulation Any Return of Spontaneous Circulation Any Return of Spontaneous Circulation Any Return of Spontaneous Circulation Any Return of Spontaneous Circulation Neurological Outcome at Hospital Discharge Neurological Outcome at Hospital Discharge Neurological Outcome at Hospital Discharge Neurological Outcome at Hospital Discharge
-5 0 2240 2245 -25 -15 -10 -5 2250 2255 2260 2265 2270 2275 -25 -15 -10 -5 2280 2285 2290 2295 2300 2305 -25 -10 -5 2310 2315 2320 -25 -10 -5 2325 2330 2335 2340 2345 2350 2355 2360 2365 -25 -10 -5 0 2370 2375 -25 -10 -5 2380
Neurological Outcome at Hospital Discharge Estimated Time of Arrest Prior to EMS Arrival Estimated Time of Arrest Prior to EMS Arrival Estimated Time of Arrest Prior to EMS Arrival Estimated Time of Arrest Prior to EMS Arrival Estimated Time of Arrest Prior to EMS Arrival Estimated Time of Arrest Prior to EMS Arrival Estimated Time of Arrest Prior to EMS Arrival Estimated Time of Arrest Prior to EMS Arrival Estimated Time of Arrest Prior to EMS Arrival Estimated Time of Arrest Prior to EMS Arrival Estimated Time of Arrest Prior to EMS Arrival Date/Time Resuscitation Discontinued Reason CPR Discontinued Reason CPR Discontinued Reason CPR Discontinued Reason CPR Discontinued Reason CPR Discontinued Reason CPR Discontinued Reason CPR Discontinued Reason CPR Discontinued Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination Cardiac Rhythm on Arrival at Destination
2385 -25 -10 -5 2390 2395 2400 2405 2410 2415 2420 2425 10001 -25 -10 -5 2430 2435 2440 2445 2450 -25 -10 -5 2455 2460 2465 2470 2475 2480 2485 2490 2495 2500 2505 2510 2515 2520 2525 2530 2535 2540 2545 2550 2555 2560 2565 2570 2575 2580 2585 2590
Cardiac Rhythm on Arrival at Destination Barriers to Patient Care Barriers to Patient Care Barriers to Patient Care Barriers to Patient Care Barriers to Patient Care Barriers to Patient Care Barriers to Patient Care Barriers to Patient Care Barriers to Patient Care Barriers to Patient Care Barriers to Patient Care Barriers to Patient Care Barriers to Patient Care Sending Facility Medical Record Number Sending Facility Medical Record Number Sending Facility Medical Record Number Sending Facility Medical Record Number Destination Medical Record Number Destination Medical Record Number Destination Medical Record Number Destination Medical Record Number First Name of Patient's Primary Practitioner First Name of Patient's Primary Practitioner First Name of Patient's Primary Practitioner First Name of Patient's Primary Practitioner Middle Name of Patient's Primary Practitioner Middle Name of Patient's Primary Practitioner Middle Name of Patient's Primary Practitioner Middle Name of Patient's Primary Practitioner Last Name of Patient's Primary Practitioner Last Name of Patient's Primary Practitioner Last Name of Patient's Primary Practitioner Last Name of Patient's Primary Practitioner Advanced Directives Advanced Directives Advanced Directives Advanced Directives Advanced Directives Advanced Directives Advanced Directives Advanced Directives Advanced Directives Medication Allergies Medication Allergies Medication Allergies Medication Allergies Medication Allergies Environmental/Food Allergies Environmental/Food Allergies Environmental/Food Allergies Environmental/Food Allergies
2595 -25 -15 -10 -5 2600 2605 2610 2615 2620 2625 2630 2635 2640 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 2645 2650 2655 2660 2665 2670 -25 -10 -5 10001 10008 -25 -10 -5 2675
Environmental/Food Allergies Environmental/Food Allergies Environmental/Food Allergies Environmental/Food Allergies Environmental/Food Allergies Medical/Surgical History Medical/Surgical History Medical/Surgical History Medical/Surgical History Medical History Obtained From Medical History Obtained From Medical History Obtained From Medical History Obtained From Medical History Obtained From Medical History Obtained From Medical History Obtained From Medical History Obtained From Immunization History Immunization History Immunization History Immunization History Immunization History Immunization History Immunization History Immunization History Immunization History Immunization History Immunization History Immunization Date Immunization Date Immunization Date Immunization Date Current Medications Current Medication Dose Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Dosage Unit Current Medication Administration Route Current Medication Administration Route
2680 2685 2690 2695 2700 -25 -10 -5 10001 -25 -10 -5 2705 2710 2715 2720 2725 2730 2735 2740 2745 2750 2755 2760 2765 2770 2775 2780 -25 -10 -5 10001 10001 10001 2785 2790 2795 2800 2805 2810 2815 2820 2825 2830 2835 2840 2845 2850 2855 2860 -25 -10
Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Current Medication Administration Route Presence of Emergency Information Form Presence of Emergency Information Form Presence of Emergency Information Form Presence of Emergency Information Form Presence of Emergency Information Form Alcohol/Drug Use Indicators Alcohol/Drug Use Indicators Alcohol/Drug Use Indicators Alcohol/Drug Use Indicators Alcohol/Drug Use Indicators Alcohol/Drug Use Indicators Alcohol/Drug Use Indicators Alcohol/Drug Use Indicators Pregnancy Pregnancy Pregnancy Pregnancy Pregnancy Run Report Narrative Run Report Narrative Run Report Narrative Run Report Narrative Date/Time Vital Signs Taken Obtained Prior to this Units EMS Care Obtained Prior to this Units EMS Care Obtained Prior to this Units EMS Care Obtained Prior to this Units EMS Care Obtained Prior to this Units EMS Care
-5 2865 2870 2875 2880 2890 2895 2900 2905 2910 2915 2920 2925 2930 2935 2940 2945 2950 2955 2960 2965 2970 2975 2980 -25 -10 -5 0 1 -25 -15 -10 -5 2985 2990 2995 3000 -25 -10 -5 0 1 -25 -10 -5 10001 10001 -25 -10 -5 0 1
Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm Cardiac Rhythm SBP (Systolic Blood Pressure) DBP (Diastolic Blood Pressure) Method of Blood Pressure Measurement Method of Blood Pressure Measurement Method of Blood Pressure Measurement Method of Blood Pressure Measurement Method of Blood Pressure Measurement Pulse Rate Electronic Monitor Rate Pulse Oximetry Pulse Rhythm Pulse Rhythm Pulse Rhythm Pulse Rhythm Pulse Rhythm Respiratory Rate Respiratory Effort Respiratory Effort Respiratory Effort Respiratory Effort
-25 -10 -5 3005 3010 3015 3020 3025 3030 3035 3040 3045 3050 3055 3060 3065 3070 3075 3080 3085 3090 3095 3100 3105 3110 3115 3120 3125 3130 3135 3140 3145 10001 10001 3150 3155 3160 3165 3170 10001 10001 10001 -25 -10 -5 3175 3180 10001 -25 -10 -5 3185
E14_12 E14_12 E14_12 E14_12 E14_13 E14_14 E14_15 E14_15 E14_15 E14_15 E14_15 E14_15 E14_15 E14_15 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_16 E14_17 E14_17
Respiratory Effort Respiratory Effort Respiratory Effort Respiratory Effort Carbon Dioxide Blood Glucose Level Glasgow Coma Score-Eye Glasgow Coma Score-Eye Glasgow Coma Score-Eye Glasgow Coma Score-Eye Glasgow Coma Score-Eye Glasgow Coma Score-Eye Glasgow Coma Score-Eye Glasgow Coma Score-Eye Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Verbal Glasgow Coma Score-Motor Glasgow Coma Score-Motor
3190 3195 3200 3205 10001 10001 18000 18000.5 18001 18001.5 18002 18002.5 18003 18003.5 18004 18005 18006 18007 18008 18009 18010 18011 18012 18013 18016 18016.5 18017 18017.5 18018 18018.5 18019 18019.5 18020 18021 18022 18023 18024 18025 18026 18027 18028 18029 18030 18031 18032
E14_17 Glasgow Coma Score-Motor E14_17 Glasgow Coma Score-Motor E14_17 Glasgow Coma Score-Motor E14_17 Glasgow Coma Score-Motor E14_17 Glasgow Coma Score-Motor E14_17 E14_17 E14_17 E14_17 Glasgow Coma Score-Motor Glasgow Coma Score-Motor Glasgow Coma Score-Motor Glasgow Coma Score-Motor
E14_17 Glasgow Coma Score-Motor
E14_18 Glasgow Coma Score-Qualifier E14_18 Glasgow Coma Score-Qualifier E14_18 Glasgow Coma Score-Qualifier E14_18 E14_18 E14_18 E14_18 E14_19 E14_20 E14_21 E14_21 E14_21 E14_21 E14_21 E14_22 E14_22 E14_22 E14_22 E14_22 E14_22 E14_22 E14_23 E14_24 E14_24 E14_24 E14_24 E14_24 E14_24 E14_24 E14_24 E14_24 E14_25 E14_25 E14_25 E14_25 E14_25 E14_25 E14_26 E14_27 E14_28 E15_01 E15_01 E15_01 E15_01 E15_01 E15_01 E15_01 E15_01 E15_01 E15_01 E15_01 Glasgow Coma Score-Qualifier Glasgow Coma Score-Qualifier Glasgow Coma Score-Qualifier Glasgow Coma Score-Qualifier Total Glasgow Coma Score Temperature Temperature Method Temperature Method Temperature Method Temperature Method Temperature Method Level of Responsiveness Level of Responsiveness Level of Responsiveness Level of Responsiveness Level of Responsiveness Level of Responsiveness Level of Responsiveness Pain Scale Stroke Scale Stroke Scale Stroke Scale Stroke Scale Stroke Scale Stroke Scale Stroke Scale Stroke Scale Stroke Scale Thrombolytic Screen Thrombolytic Screen Thrombolytic Screen Thrombolytic Screen Thrombolytic Screen Thrombolytic Screen APGAR Revised Trauma Score Pediatric Trauma Score NHTSA Injury Matrix External/Skin NHTSA Injury Matrix External/Skin NHTSA Injury Matrix External/Skin NHTSA Injury Matrix External/Skin NHTSA Injury Matrix External/Skin NHTSA Injury Matrix External/Skin NHTSA Injury Matrix External/Skin NHTSA Injury Matrix External/Skin NHTSA Injury Matrix External/Skin NHTSA Injury Matrix External/Skin NHTSA Injury Matrix External/Skin
-25 -10 -5 3210 3215 3220 3225 10001 10001 3230 3235 3240 3245 3250 -25 -10 -5 3255 3260 3265 3270 10001 -25 -10 -5 3275 3280 3285 3290 3295 3300 -25 -10 -5 3305 3310 3315 10001 10001 10001 -25 -10 -5 3320 3325 3330 3335 3340 3345 3350 3355
NHTSA Injury Matrix External/Skin NHTSA Injury Matrix External/Skin NHTSA Injury Matrix External/Skin NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Head NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Face NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Neck NHTSA Injury Matrix Thorax NHTSA Injury Matrix Thorax NHTSA Injury Matrix Thorax NHTSA Injury Matrix Thorax NHTSA Injury Matrix Thorax NHTSA Injury Matrix Thorax NHTSA Injury Matrix Thorax
3360 3365 3370 -25 -10 -5 3320 3325 3330 3335 3340 3345 3350 3355 3360 3365 3370 -25 -10 -5 3320 3325 3330 3335 3340 3345 3350 3355 3360 3365 3370 -25 -10 -5 3320 3325 3330 3335 3340 3345 3350 3355 3360 3365 3370 -25 -10 -5 3320 3325 3330 3335
NHTSA Injury Matrix Thorax NHTSA Injury Matrix Thorax NHTSA Injury Matrix Thorax NHTSA Injury Matrix Thorax NHTSA Injury Matrix Thorax NHTSA Injury Matrix Thorax NHTSA Injury Matrix Thorax NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Abdomen NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Spine NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Upper Extremities NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Pelvis
3340 3345 3350 3355 3360 3365 3370 -25 -10 -5 3320 3325 3330 3335 3340 3345 3350 3355 3360 3365 3370 -25 -10 -5 3320 3325 3330 3335 3340 3345 3350 3355 3360 3365 3370 -25 -10 -5 3320 3325 3330 3335 3340 3345 3350 3355 3360 3365 3370 -25 -10 -5
NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Pelvis NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Lower Extremities NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified NHTSA Injury Matrix Unspecified Estimated Body Weight Broselow/Luten Color Broselow/Luten Color Broselow/Luten Color Broselow/Luten Color Broselow/Luten Color Broselow/Luten Color Broselow/Luten Color Broselow/Luten Color Broselow/Luten Color Broselow/Luten Color Broselow/Luten Color Broselow/Luten Color
3320 3325 3330 3335 3340 3345 3350 3355 3360 3365 3370 -25 -10 -5 3320 3325 3330 3335 3340 3345 3350 3355 3360 3365 3370 -25 -10 -5 3320 3325 3330 3335 3340 3345 3350 3355 3360 3365 3370 10001 -25 -10 -5 3375 3380 3385 3390 3395 3400 3405 3410 3415
Date/Time of Assessment Skin Assessment Skin Assessment Skin Assessment Skin Assessment Skin Assessment Skin Assessment Skin Assessment Skin Assessment Skin Assessment Skin Assessment Skin Assessment Skin Assessment Skin Assessment Head/Face Assessment Head/Face Assessment Head/Face Assessment Head/Face Assessment Head/Face Assessment Head/Face Assessment Head/Face Assessment Head/Face Assessment Head/Face Assessment Neck Assessment Neck Assessment Neck Assessment Neck Assessment Neck Assessment Neck Assessment Neck Assessment Neck Assessment Neck Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Chest/Lungs Assessment Heart Assessment Heart Assessment Heart Assessment Heart Assessment
10001 -25 -10 -5 3420 3425 3430 3435 3440 3445 3450 3455 3460 3465 -25 -10 -5 3470 3475 3480 3485 3490 3495 -25 -10 -5 3500 3505 3510 3515 3520 3525 -25 -10 -5 3530 3535 3540 3545 3550 3555 3560 3565 3570 3575 3580 3585 3590 -25 -10 -5 3595
Heart Assessment Heart Assessment Heart Assessment Abdomen Left Upper Assessment Abdomen Left Upper Assessment Abdomen Left Upper Assessment Abdomen Left Upper Assessment Abdomen Left Upper Assessment Abdomen Left Upper Assessment Abdomen Left Upper Assessment Abdomen Left Upper Assessment Abdomen Left Upper Assessment Abdomen Left Lower Assessment Abdomen Left Lower Assessment Abdomen Left Lower Assessment Abdomen Left Lower Assessment Abdomen Left Lower Assessment Abdomen Left Lower Assessment Abdomen Left Lower Assessment Abdomen Left Lower Assessment Abdomen Left Lower Assessment Abdomen Right Upper Assessment Abdomen Right Upper Assessment Abdomen Right Upper Assessment Abdomen Right Upper Assessment Abdomen Right Upper Assessment Abdomen Right Upper Assessment Abdomen Right Upper Assessment Abdomen Right Upper Assessment Abdomen Right Upper Assessment Abdomen Right Lower Assessment Abdomen Right Lower Assessment Abdomen Right Lower Assessment Abdomen Right Lower Assessment Abdomen Right Lower Assessment Abdomen Right Lower Assessment Abdomen Right Lower Assessment Abdomen Right Lower Assessment Abdomen Right Lower Assessment GU Assessment GU Assessment GU Assessment GU Assessment GU Assessment GU Assessment GU Assessment GU Assessment GU Assessment Back Cervical Assessment Back Cervical Assessment Back Cervical Assessment Back Cervical Assessment
3600 3605 3610 -25 -10 -5 3615 3620 3625 3630 3635 3640 -25 -10 -5 3645 3650 3655 3660 3665 3670 -25 -10 -5 3675 3680 3685 3690 3695 3700 -25 -10 -5 3705 3710 3715 3720 3725 3730 -25 -10 -5 3735 3740 3745 3750 3755 3760 -25 -10 -5 3765
Back Cervical Assessment Back Cervical Assessment Back Cervical Assessment Back Cervical Assessment Back Thoracic Assessment Back Thoracic Assessment Back Thoracic Assessment Back Thoracic Assessment Back Thoracic Assessment Back Thoracic Assessment Back Thoracic Assessment Back Thoracic Assessment Back Lumbar/Sacral Assessment Back Lumbar/Sacral Assessment Back Lumbar/Sacral Assessment Back Lumbar/Sacral Assessment Back Lumbar/Sacral Assessment Back Lumbar/Sacral Assessment Back Lumbar/Sacral Assessment Back Lumbar/Sacral Assessment Extremities-Right Upper Assessment Extremities-Right Upper Assessment Extremities-Right Upper Assessment Extremities-Right Upper Assessment Extremities-Right Upper Assessment Extremities-Right Upper Assessment Extremities-Right Upper Assessment Extremities-Right Upper Assessment Extremities-Right Upper Assessment Extremities-Right Upper Assessment Extremities-Right Lower Assessment Extremities-Right Lower Assessment Extremities-Right Lower Assessment Extremities-Right Lower Assessment Extremities-Right Lower Assessment Extremities-Right Lower Assessment Extremities-Right Lower Assessment Extremities-Right Lower Assessment Extremities-Right Lower Assessment Extremities-Right Lower Assessment Extremities-Left Upper Assessment Extremities-Left Upper Assessment Extremities-Left Upper Assessment Extremities-Left Upper Assessment Extremities-Left Upper Assessment Extremities-Left Upper Assessment Extremities-Left Upper Assessment Extremities-Left Upper Assessment Extremities-Left Upper Assessment Extremities-Left Upper Assessment Extremities-Left Lower Assessment Extremities-Left Lower Assessment
3770 3775 3780 3785 -25 -10 -5 3790 3795 3800 3805 3810 -25 -10 -5 3815 3820 3825 3830 3835 -25 -10 -5 3840 3845 3850 3855 3860 3865 3870 -25 -10 -5 3875 3880 3885 3890 3895 3900 3905 -25 -10 -5 3910 3915 3920 3925 3930 3935 3940 -25 -10
Extremities-Left Lower Assessment Extremities-Left Lower Assessment Extremities-Left Lower Assessment Extremities-Left Lower Assessment Extremities-Left Lower Assessment Extremities-Left Lower Assessment Extremities-Left Lower Assessment Extremities-Left Lower Assessment Eyes-Left Assessment Eyes-Left Assessment Eyes-Left Assessment Eyes-Left Assessment Eyes-Left Assessment Eyes-Left Assessment Eyes-Left Assessment Eyes-Left Assessment Eyes-Left Assessment Eyes-Left Assessment Eyes-Left Assessment Eyes-Left Assessment Eyes-Left Assessment Eyes-Right Assessment Eyes-Right Assessment Eyes-Right Assessment Eyes-Right Assessment Eyes-Right Assessment Eyes-Right Assessment Eyes-Right Assessment Eyes-Right Assessment Eyes-Right Assessment Eyes-Right Assessment Eyes-Right Assessment Eyes-Right Assessment Eyes-Right Assessment Mental Status Assessment Mental Status Assessment Mental Status Assessment Mental Status Assessment Mental Status Assessment Mental Status Assessment Mental Status Assessment Mental Status Assessment Mental Status Assessment Mental Status Assessment Mental Status Assessment Mental Status Assessment Neurological Assessment Neurological Assessment Neurological Assessment Neurological Assessment Neurological Assessment Neurological Assessment
-5 3945 3950 3955 3960 3965 3970 3975 -25 -10 -5 3980 3985 3990 3995 4000 4005 4010 4015 4020 4025 -25 -10 -5 4030 4035 4040 4045 4050 4055 4060 4065 4070 4075 -25 -10 -5 4080 4085 4090 4095 4100 4105 4110 4115 4120 -25 -10 -5 4125 4130 4135
Neurological Assessment Neurological Assessment Neurological Assessment Neurological Assessment Neurological Assessment Neurological Assessment Neurological Assessment Protocols Used Protocols Used Protocols Used Protocols Used Date/Time Medication Administered Medication Administered Prior to this Units EMS Care Medication Administered Prior to this Units EMS Care Medication Administered Prior to this Units EMS Care Medication Administered Prior to this Units EMS Care Medication Administered Prior to this Units EMS Care Medication Given Medication Given Medication Given Medication Given Medication Given Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Administered Route Medication Dosage Medication Dosage Units Medication Dosage Units
4140 4145 4150 4155 4160 4165 4170 -25 -10 -5 10001 10001 -25 -10 -5 0 1 -25 -15 -10 -5 10001 -25 -10 -5 4175 4180 4185 4190 4191 4200 4205 4210 4215 4220 4225 4230 4235 4240 4245 4250 4255 4260 4265 4270 4275 4280 4285 4290 10001 4295 4300
Medication Dosage Units Medication Dosage Units Medication Dosage Units Medication Dosage Units Medication Dosage Units Medication Dosage Units Medication Dosage Units Medication Dosage Units Medication Dosage Units Medication Dosage Units Medication Dosage Units Medication Dosage Units Medication Dosage Units Medication Dosage Units Response to Medication Response to Medication Response to Medication Response to Medication Response to Medication Response to Medication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Complication Medication Crew Member ID Medication Crew Member ID Medication Crew Member ID Medication Crew Member ID Medication Authorization Medication Authorization Medication Authorization Medication Authorization Medication Authorization Medication Authorization
4305 4310 4315 4320 4325 4330 4335 4340 4345 4350 4355 4360 4365 4370 -25 -10 -5 4375 4380 4385 -25 -15 -10 -5 4390 4395 4400 4405 4410 4415 4420 4425 4430 4435 4440 4445 4450 4455 4460 4465 4470 4475 -25 -10 -5 10001 -25 -10 -5 4480 4485 4490
Medication Authorization Medication Authorizing Physician Medication Authorizing Physician Medication Authorizing Physician Medication Authorizing Physician Date/Time Procedure Performed Successfully Procedure Performed Prior to this Units EMS Care Procedure Performed Prior to this Units EMS Care Procedure Performed Prior to this Units EMS Care Procedure Performed Prior to this Units EMS Care Procedure Performed Prior to this Units EMS Care Procedure Procedure Procedure Procedure Procedure Size of Procedure Equipment Size of Procedure Equipment Size of Procedure Equipment Size of Procedure Equipment Number of Procedure Attempts Number of Procedure Attempts Number of Procedure Attempts Number of Procedure Attempts Number of Procedure Attempts Procedure Successful Procedure Successful Procedure Successful Procedure Successful Procedure Successful Procedure Successful Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication Procedure Complication
4495 -25 -10 -5 10001 10001 -25 -10 -5 0 1 -25 -15 -10 -5 10001 -25 -10 -5 10001 -25 -15 -10 -5 10001 -25 -15 -10 -5 0 1 -25 -15 -10 -5 4500 4505 4510 4515 4520 4525 4530 4535 4540 4545 4550 4555 4560 4565 4570 4575 4580
Procedure Complication Procedure Complication Procedure Complication Response to Procedure Response to Procedure Response to Procedure Response to Procedure Response to Procedure Response to Procedure Procedure Crew Members ID Procedure Crew Members ID Procedure Crew Members ID Procedure Crew Members ID Procedure Authorization Procedure Authorization Procedure Authorization Procedure Authorization Procedure Authorization Procedure Authorization Procedure Authorization Procedure Authorizing Physician Procedure Authorizing Physician Procedure Authorizing Physician Procedure Authorizing Physician Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Successful IV Site Tube Confirmation Tube Confirmation Tube Confirmation Tube Confirmation Tube Confirmation
4585 4590 4595 -25 -10 -5 4600 4605 4610 -25 -10 -5 10001 -25 -10 -5 4615 4620 4625 4630 -25 -10 -5 10001 -25 -10 -5 4635 4640 4645 4650 4655 4660 4665 4670 4675 4680 4685 4690 4695 4700 4705 4710 4715 4720 4725 4730 -25 -10 -5 4735 4740
Tube Confirmation Tube Confirmation Tube Confirmation Tube Confirmation Tube Confirmation Tube Confirmation Destination Confirmation of Tube Placement Destination Confirmation of Tube Placement Destination Confirmation of Tube Placement Destination Confirmation of Tube Placement Destination Confirmation of Tube Placement Destination Confirmation of Tube Placement Destination Confirmation of Tube Placement Destination Confirmation of Tube Placement Destination Confirmation of Tube Placement Destination Confirmation of Tube Placement Destination Confirmation of Tube Placement Destination/Transferred To, Name Destination/Transferred To, Name Destination/Transferred To, Name Destination/Transferred To, Name Destination/Transferred To, Code Destination/Transferred To, Code Destination/Transferred To, Code Destination/Transferred To, Code Destination Street Address Destination Street Address Destination Street Address Destination Street Address Destination City Destination City Destination City Destination City Destination State Destination State Destination State Destination State Destination County Destination County Destination County Destination County Destination Zip Code Destination Zip Code Destination Zip Code Destination Zip Code Destination Zip Code Destination GPS Location Destination Zone Number Destination Zone Number Destination Zone Number Destination Zone Number Incident/Patient Disposition
4745 4750 4755 4760 4765 4770 -25 -10 -5 4775 4780 4785 4790 4795 4800 4805 4810 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -15 -10 -5 10001 10001 -25 -10 -5 10001 4815
Incident/Patient Disposition Incident/Patient Disposition Incident/Patient Disposition Incident/Patient Disposition Incident/Patient Disposition Incident/Patient Disposition Incident/Patient Disposition Incident/Patient Disposition Incident/Patient Disposition How Patient Was Moved to Ambulance How Patient Was Moved to Ambulance How Patient Was Moved to Ambulance How Patient Was Moved to Ambulance How Patient Was Moved to Ambulance How Patient Was Moved to Ambulance How Patient Was Moved to Ambulance How Patient Was Moved to Ambulance Position of Patient During Transport Position of Patient During Transport Position of Patient During Transport Position of Patient During Transport Position of Patient During Transport Position of Patient During Transport Position of Patient During Transport Position of Patient During Transport Position of Patient During Transport Position of Patient During Transport Position of Patient During Transport How Patient Was Transported From Ambulance How Patient Was Transported From Ambulance How Patient Was Transported From Ambulance How Patient Was Transported From Ambulance How Patient Was Transported From Ambulance How Patient Was Transported From Ambulance How Patient Was Transported From Ambulance How Patient Was Transported From Ambulance Transport Mode from Scene Transport Mode from Scene Transport Mode from Scene Transport Mode from Scene Transport Mode from Scene Transport Mode from Scene Transport Mode from Scene Transport Mode from Scene Condition of Patient at Destination Condition of Patient at Destination Condition of Patient at Destination Condition of Patient at Destination Condition of Patient at Destination Condition of Patient at Destination Reason for Choosing Destination Reason for Choosing Destination
4820 4825 4830 4835 4840 4845 4850 4855 4860 -25 -10 -5 4865 4870 4875 4880 4885 -25 -10 -5 4890 4895 4900 4905 4910 4915 4920 4925 -25 -10 -5 4930 4935 4940 4945 4950 -25 -15 -10 -5 4955 4960 4965 4970 -25 -10 -5 4975 4980 4985 -25 -15
Reason for Choosing Destination Reason for Choosing Destination Reason for Choosing Destination Reason for Choosing Destination Reason for Choosing Destination Reason for Choosing Destination Reason for Choosing Destination Reason for Choosing Destination Reason for Choosing Destination Reason for Choosing Destination Reason for Choosing Destination Reason for Choosing Destination Reason for Choosing Destination Type of Destination Type of Destination Type of Destination Type of Destination Type of Destination Type of Destination Type of Destination Type of Destination Type of Destination Type of Destination Type of Destination Type of Destination Type of Destination Event Date/Time Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name Medical Device Event Name
-10 -5 4990 4995 5000 5005 5010 5015 5020 5025 5030 5035 5040 -25 -15 -10 -5 7270 7280 7290 7300 7310 7320 7340 7350 7360 10001 -25 -10 -5 5090 5095 5100 5105 5110 5115 5120 5125 5130 5135 5140 5145 5150 5155 5160 5165 5170 5175 5180 5185 5190 5195
Waveform Graphic Type Waveform Graphic Type Waveform Graphic AED, Pacing, or CO2 Mode AED, Pacing, or CO2 Mode AED, Pacing, or CO2 Mode AED, Pacing, or CO2 Mode AED, Pacing, or CO2 Mode AED, Pacing, or CO2 Mode AED, Pacing, or CO2 Mode ECG Lead ECG Lead ECG Lead ECG Lead ECG Lead ECG Lead ECG Lead ECG Lead ECG Lead ECG Lead ECG Lead ECG Lead ECG Lead ECG Interpretation Type of Shock Type of Shock Shock or Pacing Energy Total Number of Shocks Delivered Pacing Rate Device Heart Rate Device Pulse Rate Device Systolic Blood Pressure Device Diastolic Blood Pressure Device Respiratory Rate Device Pulse Oximetry Device CO2 or etCO2 Device CO2, etCO2, or Invasive Pressure Monitor Units Device CO2, etCO2, or Invasive Pressure Monitor Units Device CO2, etCO2, or Invasive Pressure Monitor Units Device Invasive Pressure Mean Emergency Department Disposition Emergency Department Disposition Emergency Department Disposition Emergency Department Disposition Emergency Department Disposition Emergency Department Disposition Emergency Department Disposition Emergency Department Disposition Emergency Department Disposition Emergency Department Disposition Hospital Disposition Hospital Disposition
5200 5205 10001 5210 5215 5220 5225 5230 5235 5240 5245 5250 5255 5260 5265 5270 5275 5280 5285 5290 5295 5300 5305 10001 5310 5311 10001 10001 10001 10001 10001 10001 10001 10001 10001 10001 5320 5325 5330 10001 -25 -15 -10 -5 5335 5340 5345 5350 5355 5360 -25 -15
Hospital Disposition Hospital Disposition Hospital Disposition Hospital Disposition Hospital Disposition Hospital Disposition Hospital Disposition Hospital Disposition Law Enforcement/Crash Report Number Law Enforcement/Crash Report Number Law Enforcement/Crash Report Number Law Enforcement/Crash Report Number Trauma Registry ID Trauma Registry ID Trauma Registry ID Trauma Registry ID Fire Incident Report Number Fire Incident Report Number Fire Incident Report Number Fire Incident Report Number Patient ID Band/Tag Number Patient ID Band/Tag Number Patient ID Band/Tag Number Patient ID Band/Tag Number Review Requested Review Requested Review Requested Review Requested Review Requested Potential Registry Candidate Potential Registry Candidate Potential Registry Candidate Potential Registry Candidate Potential Registry Candidate Potential Registry Candidate Potential Registry Candidate Potential Registry Candidate Potential Registry Candidate Potential Registry Candidate Potential Registry Candidate Personal Protective Equipment Used Personal Protective Equipment Used Personal Protective Equipment Used Personal Protective Equipment Used Personal Protective Equipment Used Personal Protective Equipment Used Personal Protective Equipment Used Personal Protective Equipment Used Personal Protective Equipment Used Personal Protective Equipment Used Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster
-10 -5 5365 5370 5375 5380 5385 5390 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 10001 -25 -10 -5 0 1 -25 -10 -5 5395 5400 5405 5410 5415 5420 5425 5430 -25 -10 -5 5435 5440 5445 5450 5455 5460 5465 -25 -10
E23_04 E23_04 E23_04 E23_04 E23_04 E23_04 E23_04 E23_04 E23_04 E23_04 E23_04 E23_04 E23_04 E23_04
Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster Suspected Intentional, or Unintentional Disaster
-5 5470 5475 5480 5485 5490 5495 5500 5505 5510 5515 5520 5525 5530 -25 -10 -5 0 1 -25 -10 -5 5540 5545 5550 5555 5560 5565 5570 5575 5580 5585 -25 -10 -5 5590 5595 5600 -25 -10 -5 0 1 -25 -10 -5 10001
E23_05 Suspected Contact with Blood/Body Fluids of EMS Injury or Death E23_05 Suspected Contact with Blood/Body Fluids of EMS Injury or Death E23_05 Suspected Contact with Blood/Body Fluids of EMS Injury or Death E23_05 Suspected Contact with Blood/Body Fluids of EMS Injury or Death E23_05 E23_06 E23_06 E23_06 E23_06 E23_06 E23_06 E23_06 E23_06 E23_06 E23_06 E23_06 E23_06 E23_06 E23_07 E23_07 E23_07 E23_07 E23_07 E23_07 E23_08 E23_08 E23_08 E23_08 E23_08 E23_09 E23_09 E23_09 E23_09 Suspected Contact with Blood/Body Fluids of EMS Injury or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Type of Suspected Blood/Body Fluid Exposure, Injury, or Death Personnel Exposed Personnel Exposed Personnel Exposed Personnel Exposed Personnel Exposed Personnel Exposed Required Reportable Conditions Required Reportable Conditions Required Reportable Conditions Required Reportable Conditions Required Reportable Conditions Research Survey Field Research Survey Field Research Survey Field Research Survey Field
E23_10 E23_10 E23_10 E23_10 E23_11
Who Generated this Report? Who Generated this Report? Who Generated this Report? Who Generated this Report? Research Survey Field Title
-25 -10 -5 10001 10001
Variable Appropriate 2 digit FIPS code Appropriate 5 digit FIPS code 911 Response (Scene) with Transport Capability 911 Response (Scene) without Transport Capability Air Medical Hazmat Medical Transport (Convalescent) Paramedic Intercept Rescue Specialty Care Transport Not Applicable Not Known Not Available 911 Response (Scene) with Transport Capability 911 Response (Scene) without Transport Capability Air Medical Hazmat Medical Transport (Convalescent) Paramedic Intercept Rescue Specialty Care Transport EMT-Basic EMT-Intermediate EMT-Paramedic Nurse Physician First Responder Community, Non-Profit Fire Department Governmental, Non-Fire Hospital Private, Non_Hospital Tribal Mixed Non-Volunteer Volunteer Not Applicable Not Known Not Available GMT-11:00 Midway Island, Samoa GMT-10:00 Hawaii GMT-09:00 Alaska GMT-08:00 Pacific Time GMT-07:00 Mountain Time GMT-06:00 Central Time GMT-05:00 Eastern Time GMT-04:00 Atlantic Time No Yes Not Applicable Not Reporting
Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known
Not Available Anesthesiology Cardiology Emergency Medicine Family Practice General Practice (not board certified) Internal Medicine Obstetrics and Gynecology Orthopedics Other Pediatrics Surgery Not Applicable Not Known Not Available EMT-Basic EMT-Intermediate EMT-Paramedic Nurse Physician First Responder CNS Catheter-Epidural Maintenance CNS Catheter-Intraventricular Maintenance Airway-Needle Cricothyrotomy Airway-Surgical Cricothyrotomy Airway-Direct Laryngoscopy Airway-Video Laryngoscopy Chest Decompression Chest Tube Placement Pericardiocentesis Intra-Aortic Balloon Pump Maintenance Left Ventricular Assist Device Maintenance Arterial Access-Blood Draw Venous Access-Blood Draw Venous Access-Existing Catheter Venous Access-Extremity Venous Access-External Jugular Line Venous Access-Femoral Line Blood Glucose Analysis Venous Access-Internal Jugular Line Venous Access-Subclavian Line Venous Access-Discontinue Venous Access-Umbilical Vein Cannulation Venous Access-Intraosseous Adult Venous Access-Intraosseous Pediatric Urinary Catheterization Childbirth Joint Reduction/Relocation Escharotomy Decontamination Capnography (CO2 Measurement) Pulse Oximetry
Cardiac Monitor Orthostatic Blood Pressure Measurement Patient Monitoring of Pre-existing Devices, Equipment, or Ongoing Medications Arterial Line Maintenance Venous Access-Central Line Maintenance Venous Access-Swan Ganz Maintenance Assessment-Adult Assessment-Pediatric Pain Measurement Temperature Measurement Thrombolytic Screen 12 Lead ECG-Obtain 12 Lead ECG-Transmitted Wound Care-Taser Barb Removal Wound Care-Tourniquet Wound Care-General Wound Care-Irrigation Wound Care-Hemostatic Agent Patient Warming (Hot Pack, etc.) Splinting-Traction Splinting-Basic MAST Spinal Immobilization Airway-CPAP Airway-Respirator Operation (BLS) Airway-Bagged (via tube) Airway-Bagged (via BVMask) Airway-Nebulizer Treatment Airway-Nasal Airway-Oral Airway-EOA/EGTA Airway-Orotracheal Intubation Airway-Nasotracheal Intubation Airway-Rapid Sequence Intubation Airway-Combitube Blind Insertion Airway Device Airway-Laryngeal Mask Blind Insertion Airway Device Airway-King LT Blind Insertion Airway Device Gastric Tube Insertion-Inserted Nasally Gastric Tube Insertion-Inserted Orally Airway-Ventilator Operation Airway-Ventilator with PEEP Airway-BiPAP Airway-Impedance Threshold Device Airway-PEEP Airway-Intubation Confirm Colorimetric ETCO2 Airway-Intubation Confirm Esophageal Bulb Airway-Extubation Airway-Change Tracheostomy Tube Airway-Intubation of Existing Tracheostomy Stoma Airway-Cleared, Opened, or Heimlich Airway-Foreign Body Removal Airway-Suctioning
Vagal Maneuver-Carotid Massage Vagal Maneuver-Valsalva or Other Vagal Maneuver (Not Carotid Massage) Restraints-Pharmacological Restraints-Physical Patient Cooling (Cold Pack, etc.) Patient Cooling-Post Resuscitation Injections-SQ/IM Cardiac Pacing-External Cardiac Pacing-Transvenous Cardioversion 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 Defibrillation-Automated (AED) Defibrillation-Manual Defibrillation-Placement for Monitoring/Analysis Rescue Extrication Patient Loaded-Helicopter Hot-Load Patient Off-Loaded Patient Off-Loaded Helicopter Hot Off-Load Specialty Center Activation-Adult Trauma Specialty Center Activation-Pediatric Trauma Specialty Center Activation-Cardiac Arrest Specialty Center Activation-STEMI Specialty Center Activation-Stroke 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 Patient Loaded Contact Medical Control Abdominal Pain Airway Airway-Failed Airway-RSI Allergic Reaction/Anaphylaxis Altered Mental Status AltitudeSickness Asystole Atrial Fibrillation Back Pain Behavioral 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 Hypertension Hyperthermia Hypoglycemia Hypotension/Shock (Non-Trauma) Hypothermia IV Access Trauma-Multisystem Newly Born Obstetrical Emergencies Overdose/Toxic Ingestion Pain Control Post Resuscitation Pulmonary Edema Pulseless Electrical Activity Respiratory Distress Seizure Spinal Cord Trauma Spinal Immobilization Supraventricular Tachycardia Stroke/TIA Syncope Trauma-Arrest Trauma-Amputation Universal Patient Care Ventricular Fibrillation Ventricular Ectopy Ventricular Tachycardia
Vomiting EMT-Basic EMT-Intermediate EMT-Paramedic Nurse Physician First Responder No Yes Not Applicable Not Known Not Available Not Applicable Not Known Not Available Home Hospital Medical Office/Clinic Morgue Nursing Home Other Other EMS Responder (air) Other EMS Responder (ground) Police/Jail Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Ambulance ATV Bicycle Boat Fire Truck Fixed Wing Motorcycle Other Private Vehicle Quick Response Vehicle (Non-Transport Vehicle other than Fire Truck Rescue Rotor Craft EMT-Basic
EMT-Intermediate EMT-Paramedic Nurse Physician First Responder Not Applicable Not Known Not Available Not Applicable Not Known Not Available Full Time Paid Employee Full Time Unpaid Employee Part Time Paid and Part Time Unpaid Employee Part Time Paid Employee Part Time Unpaid Employee EMT-Basic EMT-Intermediate EMT-Paramedic Nurse Physician First Responder Text as defined in D04_01 Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Not Applicable Not Known Not Available Male Female
American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other Race Hispanic or Latino Not Hispanic or Latino EMT-Basic EMT-Intermediate EMT-Paramedic Nurse Physician First Responder Text as defined in D04_01 Not Applicable Not Known Not Available No Yes Not Applicable Not Recorded Not Reporting Not Known Not Available Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care 911 Response (Scene) Intercept Interfacility Transfer Medical Transport Mutual Aid Standby Non-Transport Rescue Supervisor Transport Not Applicable Not Reporting Not Known Not Available 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.) Not Applicable Not Reporting Not Known Not Available Crowd Directions Distance Diversion HazMat None Other Safety Staff Delay Traffic Vehicle Crash Vehicle Failure Weather Not Applicable Not Reporting Not Known Not Available Crowd Directions Distance Diversion Extrication >20 min. HazMat Language Barrier None Other Safety Staff Delay Traffic Vehicle Crash Vehicle Failure Weather Not Applicable Not Reporting Not Known Not Available Crowd Directions Distance Diversion HazMat None Other Safety
Staff Delay Traffic Vehicle Crash Vehicle Failure Weather Not Applicable Not Reporting Not Known Not Available Clean-up Decontamination Documentation ED Overcrowding Equipment Failure Equipment Replenishment None Other Staff Delay Vehicle Failure Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care 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 Not Applicable Not Reporting Not Known Not Available Abdominal Pain Allergies Animal Bite Assault 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 Hemorrhage/Laceration Industrial Accident/Inaccessible Incident/Other Entrapments (non-vehicle) Ingestion/Poisoning Pregnancy/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 (Mass Casualty Incident) Not Applicable Not Reporting Not Known Not Available No Yes, With Pre-Arrival Instructions Yes, Without Pre-Arrival Instructions Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Driver Primary Patient Caregiver Secondary Patient Caregiver Third Patient Caregiver Other Not Applicable
Not Known Not Available Student Other Healthcare Professional Other Non-Healthcare Professional EMT-Basic EMT-Intermediate EMT-Paramedic Nurse Physician First Responder Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care
Not Applicable Not Reporting Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Reporting Not Known Not Available Male Female Not Applicable Not Reporting Not Known Not Available American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other Race Not Applicable Not Reporting Not Known Not Available Hispanic or Latino Not Hispanic or Latino Relevant Value for Data Element & Patient Care Not Applicable Not Reporting Not Known Not Available Hours Days Months Years Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available
Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Insurance Medicaid Medicare Not Billed (for any reason) Other Government Self Pay Workers Compensation Not Applicable Not Known Not Available No Yes Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Primary Secondary Other Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known
Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Reporting Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Self Spouse Son/Daughter Other Not Applicable Not Known Not Available No Yes Not Applicable Not Known Not Available Construction Finance, Insurance, and Real Estate Government Manufacturing Mining Retail Trade Services Transportation and Public Utilities Wholesale Trade Not Applicable Not Known Not Available 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 Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Appointed Guardian Father Mother Other
Son/Daughter Spouse Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Immediate Non-Immediate Not Applicable Not Reporting Not Known Not Available BLS BLS, Emergency ALS, Level 1 ALS, Level 1 Emergency ALS, Level 2 Paramedic Intercept Specialty Care Transport Fixed Wing (Airplane) Rotary Wing (Helicopter) Not Applicable Not Reporting Not Known Not Available 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-991.9) 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 other than Chest Pain (atypical pain) (ALS-536.2) Heat Exposure (ALS-992.5) Heat Exposure (BLS-992.2) Hemorrhage (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) Poisons (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) Pregnancy Complication/Childbirth/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/Sting/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) Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available 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 Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available EMS Mutual Aid Fire Hazmat Law Other Health Care Provider Other Rescue Utilities Not Applicable Not Known
Not Available >15 minutes 5 - 15 Minutes <5 Minutes After EMS Relevant Value for Data Element & Patient Care Not Applicable Not Reporting Not Known Not Available None Single Multiple Not Applicable Not Reporting Not Known Not Available No Yes Not Applicable Not Reporting Not Known Not Available 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 Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care
Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Reporting Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Reporting Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Reporting Not Known Not Available EMS Provider Law Enforcement Lay Person Other Healthcare Provider Patient Not Applicable Not Reporting Not Known Not Available Improved Unchanged Worse Not Applicable Not Reporting Not Known Not Available No Yes Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Seconds Minutes Hours Days Weeks Months Years
Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Seconds Minutes Hours Days Weeks Months Years Not Applicable Not Reporting Not Known Not Available Abdomen Back Chest Extremity-Lower Extremity-Upper General/Global Genitalia Head Neck Not Applicable Not Reporting Not Known Not Available Cardiovascular CNS/Neuro Endocrine/Metabolic GI Global Musculoskeletal OB/Gyn Psych Pulmonary Renal Skin Not Applicable Not Reporting Not Known Not Available 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 Not Applicable Not Reporting Not Known Not Available 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 Not Applicable Not Reporting Not Known Not Available 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 Not Applicable Not Reporting Not Known Not Available 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 Not Applicable Not Reporting Not Known
Not Available Aircraft related accident (E84X.0) Bicycle Accident (E826.0) Bites (E906.0) Chemical poisoning (E86X.0) Child battering (E967.0) Drowning (E910.0) Drug poisoning (E85X.0) Electrocution (non-lightning) (E925.0) Excessive Cold (E901.0) Excessive Heat (E900.0) Falls (E88X.0) Fire and Flames (E89X.0) Firearm assault (E965.0) Firearm injury (accidental) (E985.0) Firearm self inflicted (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.1) Non-Motorized Vehicle Accident (E848.0) Pedestrian traffic accident (E814.0) Radiation exposure (E926.0) Rape (E960.1) Smoke Inhalation (E89X.2) Stabbing/Cutting Accidental (E986.0) Stabbing/Cutting Assault (E966.0) Struck by Blunt/Thrown Object (E968.2) Venomous stings (plants, animals) (E905.0) Water Transport accident (E83X.0) Not Applicable Not Known Not Available Intentional, Other (Assaulted) Intentional, Self Unintentional Not Applicable Not Known Not Available Blunt Burn Other Penetrating Not Applicable Not Known Not Available Dash Deformity DOA Same Vehicle Ejection Fire
Rollover/Roof Deformity Side Post Deformity Space Intrusion >1 foot Steering Wheel Deformity Windshield Spider/Star Not Applicable Not Known Not Available Center Front Center Rear Left Front Left Rear Left Side Right Front Right Rear Right Side Roll Over Relevant Value for Data Element & Patient Care If a value of 50 is passed, the location is designated "Cargo Area" Not Applicable Not Known Not Available Driver Left (non-driver) Middle Other Right Not Applicable Not Known Not Available Child Restraint Eye Protection Helmet Worn Lap Belt None Other Personal Floatation Device Protective Clothing Protective Non-Clothing Gear Shoulder Belt Not Applicable Not Known Not Available No Airbag Present No Airbag Deployed Airbag Deployed Front Airbag Deployed Side Airbag Deployed Other (knee, airbelt, etc.) Relevant Value for Data Element & Patient Care Not Applicable Not Reporting Not Known
Not Available No Yes, Prior to EMS Arrival Yes, After EMS Arrival Not Applicable Not Reporting Not Known Not Available Presumed Cardiac Trauma Drowning Respiratory Electrocution Other Not Applicable Not Reporting Not Known Not Available Attempted Defibrillation Attempted Ventilation Initiated Chest Compressions Not Attempted-Considered Futile Not Attempted-DNR Orders Not Attempted-Signs of Circulation Not Applicable Not Known Not Available Witnessed by Healthcare Provider Witnessed by Lay Person Not Witnessed Not Applicable Not Known Not Available Asystole Bradycardia Normal Sinus Rhythm Other PEA Unknown AED Non-Shockable Rhythm Unknown AED Shockable Rhythm Ventricular Fibrillation Ventricular Tachycardia Not Applicable Not Known Not Available No Yes, Prior to ED Arrival Only Yes, Prior to ED Arrival and at the ED Not Applicable Not Known Not Available CPC 1 or 2
CPC 3 or 4 Not Applicable Not Known Not Available >20 Minutes 15-20 Minutes 10-15 Minutes 8-10 Minutes 6-8 Minutes 4-6 Minutes 2-4 Minutes 0-2 Minutes Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available DNR Medical Control Order Obvious Signs of Death Protocol/Policy Requirements Completed Return of Spontaneous Circulation (pulse or BP noted) Not Applicable Not Known Not Available 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 Not Applicable Not Reporting Not Known Not Available Developmentally Impaired Hearing Impaired Language None Physically Impaired Physically Restrained Speech Impaired Unattended or Unsupervised (including minors) Unconscious Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available State/EMS DNR Form Other Healthcare DNR Form Living Will Family/Guardian request DNR (but no documentation) Other None Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care NKDA (No Known Drug Allergies) Not Applicable Not Known Not Available Insect Sting
Food Allergy Latex Chemical Other None Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Bystander/Other Family Health Care Personnel None Patient 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 Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care GMS Inches IU KVO (TKO) L/MIN LITERS LPM MCG MCG/KG/MIN MEQ MG MG/KG/MIN ML ML/HR Other Puffs Not Applicable Not Known
Not Available Endotracheal tube Gastrostomy Inhalation Intramuscular Intraocular Intravenous Nasal Nasal prongs Nasogastric Ophthalmic Oral Other/miscellaneous Otic Non Re-breather mask Rectal Subcutaneous Sublingual Topical Tracheostomy Transdermal Urethral Ventimask Wound Not Applicable Not Known Not Available No Yes Not Applicable Not Reporting Not Known Not Available Smell of Alcohol on Breath Patient Admits to Alcohol Use Patient Admits to Drug Use Alcohol and/or Drug Paraphernalia at Scene Not Applicable Not Known Not Available No Yes Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available No Yes
Not Applicable Not Known Not Available 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 Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Arterial Line Automated Cuff Manual Cuff Palpated Cuff Venous Line Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Regular Irregular Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Normal
Labored Fatigued Absent Not Assessed Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care For All Age Groups: 1 = Does Not Open Eyes For All Age Groups: 2 = Opens Eyes to painful stimulation For All Age Groups: 3 = Opens Eyes to verbal stimulation For All Age Groups: 4 = Opens Eyes spontaneously Patients 0-23 months: 1 = None Patients 2-5 years: 1 = None Patients 0-23 months: 2 = Persistent cry Patients 2-5 years: 2 = Grunts Patients 0-23 months: 3 = Inappropriate cry Patients 2-5 years: 3 = Cries and/or screams Patients 0-23 months: 4 = Cries, inconsolable Patients 2-5 years: 4 = Inappropriate words Patients 0-23 months: 5 = Smiles, coos, cries appropriately Patients 2-5 years: 5 = Appropriate words Patients >5 years: 1 = None Patients >5 years: 2 = Non-specified sounds Patients >5 years: 3 = Inappropriate words Patients >5 years: 4 = Confused conversation or speech Patients >5 years: 5 = Oriented and appropriate speech Patients up to 5 years: 1 = None Patients >5 years: 1 = None Patients up to 5 years: 2 = Extensor posturing in response to painful stimulation Patients >5 years: 2 = Extensor posturing in response to painful stimulation Patients up to 5 years: 3 = Flexor posturing in response to painful stimulation Patients >5 years: 3 = Flexor posturing in response to painful stimulation Patients up to 5 years: 4 = General withdrawal in response to painful stimulation Patients >5 years: 4 = General withdrawal in response to painful stimulation Patients up to 5 years: 5 = Localization of painful stimulation Patients >5 years: 5 = Localization of painful stimulation Patients up to 5 years: 6 = Spontaneous Patients >5 years: 6 = Obeys commands with appropriate motor responses
Not Applicable Not Known Not Available Initial GCS has legitimate values without interventions such as intubation and sedation Patient Chemically Sedated Patient Intubated Patient Intubated and Chemically Paralyzed Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Axillary Oral Rectal Tympanic Urinary catheter Not Applicable Not Known Not Available Alert Verbal Painful Unresponsive Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available 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 Not Applicable Not Known Not Available Definite Contraindications to Thrombolytic use No Contraindications to Thrombolytic Use Possible Contraindications to Thrombolytic Use Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Amputation Bleeding Controlled Bleeding Uncontrolled Burn Crush Dislocation Fracture Gunshot Laceration
Pain without swelling/bruising Puncture/stab Soft Tissue Swelling/Bruising Not Applicable Not Known Not Available Amputation Bleeding Controlled Bleeding Uncontrolled Burn Crush Dislocation Fracture Gunshot Laceration Pain without swelling/bruising Puncture/stab Soft Tissue Swelling/Bruising Not Applicable Not Known Not Available Amputation Bleeding Controlled Bleeding Uncontrolled Burn Crush Dislocation Fracture Gunshot Laceration Pain without swelling/bruising Puncture/stab Soft Tissue Swelling/Bruising Not Applicable Not Known Not Available Amputation Bleeding Controlled Bleeding Uncontrolled Burn Crush Dislocation Fracture Gunshot Laceration Pain without swelling/bruising Puncture/stab Soft Tissue Swelling/Bruising Not Applicable Not Known Not Available Amputation Bleeding Controlled Bleeding Uncontrolled Burn
Crush Dislocation Fracture Gunshot Laceration Pain without swelling/bruising Puncture/stab Soft Tissue Swelling/Bruising Not Applicable Not Known Not Available Amputation Bleeding Controlled Bleeding Uncontrolled Burn Crush Dislocation Fracture Gunshot Laceration Pain without swelling/bruising Puncture/stab Soft Tissue Swelling/Bruising Not Applicable Not Known Not Available Amputation Bleeding Controlled Bleeding Uncontrolled Burn Crush Dislocation Fracture Gunshot Laceration Pain without swelling/bruising Puncture/stab Soft Tissue Swelling/Bruising Not Applicable Not Known Not Available Amputation Bleeding Controlled Bleeding Uncontrolled Burn Crush Dislocation Fracture Gunshot Laceration Pain without swelling/bruising Puncture/stab Soft Tissue Swelling/Bruising Not Applicable Not Known Not Available
Amputation Bleeding Controlled Bleeding Uncontrolled Burn Crush Dislocation Fracture Gunshot Laceration Pain without swelling/bruising Puncture/stab Soft Tissue Swelling/Bruising Not Applicable Not Known Not Available Amputation Bleeding Controlled Bleeding Uncontrolled Burn Crush Dislocation Fracture Gunshot Laceration Pain without swelling/bruising Puncture/stab Soft Tissue Swelling/Bruising Not Applicable Not Known Not Available Amputation Bleeding Controlled Bleeding Uncontrolled Burn Crush Dislocation Fracture Gunshot Laceration Pain without swelling/bruising Puncture/stab Soft Tissue Swelling/Bruising Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Blue Green Grey Orange Pink Purple Red White Yellow
Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Normal Not Done Clammy Cold Cyanotic Jaundiced Lividity Mottled Pale Warm Not Applicable Not Known Not Available Normal Not Done Asymmetric Smile or Droop Drainage Mass/Lesion Swelling Not Applicable Not Known Not Available Normal Not Done JVD Strider SubQ Air Tracheal Dev Not Applicable Not Known Not Available 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 Not Applicable Not Known Not Available Normal
Not Done Decreased Sounds Murmur Not Applicable Not Known Not Available Normal Not Done Distention Guarding Mass Tenderness Not Applicable Not Known Not Available Normal Not Done Distention Guarding Mass Tenderness Not Applicable Not Known Not Available Normal Not Done Distention Guarding Mass Tenderness Not Applicable Not Known Not Available Normal Not Done Distention Guarding Mass Tenderness Not Applicable Not Known Not Available Normal Not Done Crowning Genital Injury Tenderness Unstable Not Applicable Not Known Not Available Normal
Not Done Pain to ROM Tender Para-spinous Tender Spinous Process Not Applicable Not Known Not Available Normal Not Done Pain to ROM Tender Para-spinous Tender Spinous Process Not Applicable Not Known Not Available Normal Not Done Pain to ROM Tender Para-spinous Tender Spinous Process Not Applicable Not Known Not Available Normal Not Done Abnormal Pulse Abnormal Sensation Edema Tenderness Weakness Not Applicable Not Known Not Available Normal Not Done Abnormal Pulse Abnormal Sensation Edema Tenderness Weakness Not Applicable Not Known Not Available Normal Not Done Abnormal Pulse Abnormal Sensation Edema Tenderness Weakness Not Applicable Not Known
Not Available Normal Not Done Abnormal Pulse Abnormal Sensation Edema Tenderness Weakness Not Applicable Not Known Not Available Not Done 2-mm 3-mm 4-mm 5-mm 6-mm 7-mm Blind Reactive Non-Reactive Not Applicable Not Known Not Available Not Done 2-mm 3-mm 4-mm 5-mm 6-mm 7-mm Blind Reactive Non-Reactive Not Applicable Not Known Not Available Normal Not Done Combative Confused Hallucinations Oriented-Person Oriented-Place Oriented-Time Unresponsive Not Applicable Not Known Not Available Normal Not Done Abnormal Gait
Facial Droop Seizures Speech Normal Speech Slurring Tremors Weakness-Left Sided Weakness-Right Sided Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available No Yes Not Applicable Not Reporting Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Endotracheal tube Gastrostomy tube Inhalation Intramuscular Intraosseous Intraocular Intravenous Nasal Nasal prongs Nasogastric Ophthalmic Oral Other/miscellaneous Otic Re-breather mask Rectal Subcutaneous Sublingual Topical Tracheostomy Transdermal Urethral Ventimask Wound Relevant Value for Data Element & Patient Care GMS Inches
IU KVO (TKO) L/MIN LITERS LPM MCG MCG/KG/MIN MEQ MG MG/KG/MIN ML ML/HR Other Puffs Not Applicable Not Known Not Available Improved Unchanged Worse Not Applicable Not Reporting Not Known Not Available None Altered Mental Status Apnea Bleeding Bradycardia Diarrhea Extravasion Hypertension Hyperthermia Hypotension Hypoxia Injury Itching/Urticaria Nausea Other Respiratory Distress Tachycardia Vomiting Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available On-Line On-Scene Protocol (Standing Order)
Written Orders (Patient Specific) Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available No Yes Not Applicable Not Reporting Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Reporting Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Reporting Not Known Not Available No Yes Not Applicable Not Reporting Not Known Not Available 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 Not Applicable Not Known Not Available Improved Unchanged Worse Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available On-Line On-Scene Protocol (Standing Order) Written Orders (Patient Specific) Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available 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 Not Applicable Not Known Not Available 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 Not Applicable Not Known Not Available 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 Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Reporting Not Known Not Available Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care 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 Not Applicable Not Known Not Available Assisted/Walk Carry Stairchair Stretcher Other Not Applicable Not Known Not Available Car Seat Fowlers Lateral Prone Semi-Fowlers Sitting Supine Other Not Applicable Not Known Not Available Assisted/Walk Carry Stairchair Stretcher Other Not Applicable Not Reporting Not Known Not Available 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 Not Applicable Not Known Not Available Improved Unchanged Worse Not Applicable Not Reporting
Not Known Not Available 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 Not Applicable Not Reporting Not Known Not Available Home Hospital Medical Office/Clinic Morgue Nursing Home Other Other EMS Responder (air) Other EMS Responder (ground) Police/Jail Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available 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
JPG PDF Relevant Value for Data Element & Patient Care Automated Manual Advisory Demand Sensing Mid-Stream Side-Stream I II III AVR AVL AVF V1 V2 V3 V4 V5 V6 Paddle Relevant Value for Data Element & Patient Care Biphasic Monophasic Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care kPa % Volume mmHg Relevant Value for Data Element & Patient Care Not Applicable Not Reporting Not Known Not Available Admitted to Hospital Floor Admitted to Hospital ICU Death Not Applicable (Not Transported to ED) Released Transferred Not Applicable Not Reporting
Not Known Not Available Death Discharged Transfer to Hospital Transfer to Nursing Home Transfer to Other Transfer to Rehabilitation Facility Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Not Applicable Not Known Not Available No Yes Not Applicable Not Known Not Available Burn Cardiac/MI CVA/Stroke Drowning Spinal Cord Injury Trauma Traumatic Brain Injury Other Not Applicable Not Known Not Available Eye Protection Gloves Level A Suit Level B Suit Level C Suit Mask Other Not Applicable Not Known
Not Available Biologic Agent Building Failure Chemical Agent Explosive Device Fire Hostage Event Mass Gathering Nuclear Agent Radioactive Device Secondary Destructive Device Shooting/Sniper Vehicular Weather Not Applicable Not Known Not Available No Yes Not Applicable Not Known Not Available 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 Not Applicable Not Known Not Available This EMS Crew Non-EMS individual Other EMS Personnel Not Applicable Not Known Not Available No Yes Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care
Not Applicable Not Known Not Available Relevant Value for Data Element & Patient Care Relevant Value for Data Element & Patient Care

NEMSIS Data Elements and Values v2.2.1.1.2009 002

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NEMSIS Data Elements and Values v2.2.1.1.2009 002

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Number D01_03 D01_04 D01_05 D01_05 D01_05 D01_05 D01_05 D01_05 D01_05 D01_05 D01_06 D01_06 D01_06 D01_06

E14_17 Glasgow Coma Score-Motor

E23_10 E23_10 E23_10 E23_10 E23_11

-25 -10 -5 10001 10001

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