NEMSIS v3.5.0 EMSDataSet Test Case

 

NEMSIS V3 Test Case for Pre-testing
ID:               2024-EMS-2-TraumaRefusal_v350
Description:      Test case for trauma refusal of care with transport.
Expected Result:  PASS

 
Element Value
EMSDataSet - Root Tag For Patient Care Report Dataset
Header - Header for file
DemographicGroup - Demographic information related to this agency
dAgency.01 - EMS Agency Unique State ID EMS Agency Unique State ID A078
dAgency.02 - EMS Agency Number EMS Agency Number 350-A078
dAgency.04 - EMS Agency State EMS Agency State Colorado
PatientCareReport - Container Tag to hold each instance of a patient care report (PCR) [UUID = [Your UUID]]
eRecord - Patient Record Information
eRecord.01 - Patient Care Report Number [Your Patient Care Report Number]
eRecord.SoftwareApplicationGroup - Group Tag to hold information about the software used to generate this patient care report
eRecord.02 - Software Creator [Your Software Creator]
eRecord.03 - Software Name [Your Software Name]
eRecord.04 - Software Version [Your Software Version]
eResponse - Unit Agency Information
eResponse.AgencyGroup - Group Tag to hold EMS agency number and name
eResponse.01 - EMS Agency Number 350-A078
eResponse.02 - EMS Agency Name [Value from DEMDataSet]
eResponse.03 - Incident Number 350-2024-EMS2
eResponse.04 - EMS Response Number 350-2024-EMS2-1
eResponse.ServiceGroup - Group Tag to hold details about EMS category of service and the stand by reason
eResponse.05 - Type of Service Requested Emergency Response (Primary Response Area)
eResponse.07 - Unit Transport and Equipment Capability Ground Transport (ALS Equipped)
eResponse.08 - Type of Dispatch Delay Incomplete Address Information Provided
eResponse.09 - Type of Response Delay Directions/Unable to Locate
Distance
eResponse.10 - Type of Scene Delay Patient Access
eResponse.11 - Type of Transport Delay Distance
eResponse.12 - Type of Turn-Around Delay None/No Delay
eResponse.13 - EMS Vehicle (Unit) Number G194
eResponse.14 - EMS Unit Call Sign Medic 1
eResponse.16 - Vehicle Dispatch Location Poudre Valley Hospital Office
eResponse.17 - Vehicle Dispatch GPS Location 40.572568,-105.057274
eResponse.18 - Vehicle Dispatch Location US National Grid Coordinates 13TDE95159131
eResponse.19 - Beginning Odometer Reading of Responding Vehicle 341029.8
eResponse.20 - On-Scene Odometer Reading of Responding Vehicle 341061.5
eResponse.21 - Patient Destination Odometer Reading of Responding Vehicle 341093.2
eResponse.22 - Ending Odometer Reading of Responding Vehicle 341093.3
eResponse.23 - Response Mode to Scene Emergent (Immediate Response)
eResponse.24 - Additional Response Mode Descriptors Lights and No Sirens
eDispatch - Dispatch Information
eDispatch.01 - Dispatch Reason Traumatic Injury
eDispatch.02 - EMD Performed Yes, Unknown if Pre-Arrival Instructions Given
eDispatch.03 - EMD Card Number 30B3
eDispatch.04 - Dispatch Center Name or ID Larimer County Sheriff's Department
eDispatch.05 - Dispatch Priority (Patient Acuity) Emergent
eDispatch.06 - Unit Dispatched CAD Record ID LC23-18239
eCrew - Crew Member Information
eCrew.CrewGroup - Group Tag to hold crew information
eCrew.01 - Crew Member ID 455258 - Declan Collin Renner
eCrew.02 - Crew Member Level Paramedic
eCrew.03 - Crew Member Response Role Primary Patient Caregiver-At Scene
Primary Patient Caregiver-Transport
eCrew.CrewGroup - Group Tag to hold crew information
eCrew.01 - Crew Member ID 589631 - Rodrigo R Romaguera
eCrew.02 - Crew Member Level Emergency Medical Technician (EMT)
eCrew.03 - Crew Member Response Role Driver/Pilot-Response
Driver/Pilot-Transport
Other Patient Caregiver-At Scene
eTimes - Call Event Times Information
eTimes.01 - PSAP Call Date/Time October 5, 2023, 17:03:20 GMT-06:00
eTimes.02 - Dispatch Notified Date/Time October 5, 2023, 17:03:58 GMT-06:00
eTimes.03 - Unit Notified by Dispatch Date/Time October 5, 2023, 17:07:44 GMT-06:00
eTimes.04 - Dispatch Acknowledged Date/Time October 5, 2023, 17:08:12 GMT-06:00
eTimes.05 - Unit En Route Date/Time October 5, 2023, 17:09:30 GMT-06:00
eTimes.06 - Unit Arrived on Scene Date/Time October 5, 2023, 18:07:29 GMT-06:00
eTimes.07 - Arrived at Patient Date/Time October 5, 2023, 18:21:14 GMT-06:00
eTimes.08 - Transfer of EMS Patient Care Date/Time [NV = Not Applicable]
eTimes.09 - Unit Left Scene Date/Time October 5, 2023, 19:03:53 GMT-06:00
eTimes.11 - Patient Arrived at Destination Date/Time October 5, 2023, 20:00:37 GMT-06:00
eTimes.12 - Destination Patient Transfer of Care Date/Time October 5, 2023, 20:06:42 GMT-06:00
eTimes.13 - Unit Back in Service Date/Time October 5, 2023, 20:07:23 GMT-06:00
eTimes.15 - Unit Back at Home Location Date/Time October 5, 2023, 20:09:01 GMT-06:00
eTimes.16 - EMS Call Completed Date/Time October 5, 2023, 20:17:45 GMT-06:00
ePatient - Patient Information
ePatient.01 - EMS Patient ID 46sj1578
ePatient.PatientNameGroup - Group Tag to hold patient's name
ePatient.02 - Last Name Bayer
ePatient.03 - First Name Brock
ePatient.04 - Middle Initial/Name Otto
ePatient.05 - Patient's Home Address 2820 Illinois Street
ePatient.06 - Patient's Home City City of East Palo Alto
ePatient.07 - Patient's Home County San Mateo County
ePatient.08 - Patient's Home State California
ePatient.09 - Patient's Home ZIP Code 80549
ePatient.10 - Patient's Country of Residence US
ePatient.11 - Patient Home Census Tract 06081611800
ePatient.12 - Social Security Number 238562358
ePatient.13 - Gender Male
ePatient.14 - Race White
ePatient.AgeGroup - Group Tag to hold patient's age information
ePatient.15 - Age 42
ePatient.16 - Age Units Years
ePatient.17 - Date of Birth October 6, 1980
ePatient.18 - Patient's Phone Number [PhoneNumberType = Mobile] 650-686-0589
ePatient.19 - Patient's Email Address [EmailAddressType = Personal] bob78@example.com
ePatient.20 - State Issuing Driver's License California
ePatient.21 - Driver's License Number U2006373
ePayment - Insurance/Payment Information
ePayment.01 - Primary Method of Payment Self Pay
ePayment.08 - Patient Resides in Service Area Not a Resident Within EMS Service Area
ePayment.EmployerGroup - Group Tag to hold information about patient's employer
ePayment.33 - Patient's Employer Facebook
ePayment.34 - Patient's Employer's Address 1 Hacker Way
ePayment.35 - Patient's Employer's City Menlo Park
ePayment.36 - Patient's Employer's State California
ePayment.37 - Patient's Employer's ZIP Code 94025
ePayment.38 - Patient's Employer's Country US
ePayment.39 - Patient's Employer's Primary Phone Number 650-853-1300
ePayment.40 - Response Urgency Immediate
ePayment.41 - Patient Transport Assessment Unable to stand without assistance
Unable to walk without assistance
ePayment.44 - Ambulance Transport Reason Code Patient was transported to the nearest facility for care of symptoms, complaints, or both
ePayment.46 - Stretcher Purpose Description Unable to walk over half mile of trail
ePayment.47 - Ambulance Conditions Indicator Patient was admitted to a hospital
Patient was moved by stretcher
Ambulance service was medically necessary
ePayment.50 - CMS Service Level BLS, Emergency
ePayment.SupplyItemGroup - Group Tag to hold information about the supply used on the patient by the EMS Crew during the EMS event.
ePayment.55 - Supply Item Used Name Gauze Pad
ePayment.56 - Number of Supply Item(s) Used 8
ePayment.SupplyItemGroup - Group Tag to hold information about the supply used on the patient by the EMS Crew during the EMS event.
ePayment.55 - Supply Item Used Name Irrigation Solution
ePayment.56 - Number of Supply Item(s) Used 1
ePayment.SupplyItemGroup - Group Tag to hold information about the supply used on the patient by the EMS Crew during the EMS event.
ePayment.55 - Supply Item Used Name Surgical Mask
ePayment.56 - Number of Supply Item(s) Used 2
eScene - Incident Scene Information
eScene.01 - First EMS Unit on Scene [NV = Not Applicable]
eScene.06 - Number of Patients at Scene Single
eScene.07 - Mass Casualty Incident No
eScene.08 - Triage Classification for MCI Patient [NV = Not Applicable]
eScene.09 - Incident Location Type Y92.838 - Other recreation area as the place of occurrence of the external cause
eScene.10 - Incident Facility Code [NV = Not Applicable]
eScene.11 - Scene GPS Location 40.959610,-105.163771
eScene.12 - Scene US National Grid Coordinates 13TDF86213428
eScene.15 - Incident Street Address Sinking Sun Trail
eScene.17 - Incident City [NV = Not Recorded]
eScene.18 - Incident State Colorado
eScene.19 - Incident ZIP Code 80549
eScene.20 - Scene Cross Street or Directions 1/2 mile up trail from end of Red Canyon Road
eScene.21 - Incident County Larimer County
eScene.22 - Incident Country US
eScene.23 - Incident Census Tract 08069002503
eSituation - Situation Information
eSituation.01 - Date/Time of Symptom Onset October 5, 2023, 16:30:00 GMT-06:00
eSituation.02 - Possible Injury Yes
eSituation.PatientComplaintGroup - Group Tag to hold information about patient's complaint
eSituation.03 - Complaint Type Chief (Primary)
eSituation.04 - Complaint Pain in left leg and arm
eSituation.05 - Duration of Complaint 1
eSituation.06 - Time Units of Duration of Complaint Hours
eSituation.PatientComplaintGroup - Group Tag to hold information about patient's complaint
eSituation.03 - Complaint Type Secondary
eSituation.04 - Complaint Scrapes and bleeding
eSituation.05 - Duration of Complaint 1
eSituation.06 - Time Units of Duration of Complaint Hours
eSituation.07 - Chief Complaint Anatomic Location Extremity-Lower
eSituation.08 - Chief Complaint Organ System Musculoskeletal/Skin
eSituation.09 - Primary Symptom G89.11 - Acute pain due to trauma
eSituation.10 - Other Associated Symptoms M79.6 - Pain in limb, hand, foot, fingers and toes
R22 - Localized swelling, mass and lump of skin and subcutaneous tissue
R58 - Hemorrhage, not elsewhere classified
eSituation.11 - Provider's Primary Impression S79.92 - Unspecified injury of thigh
eSituation.12 - Provider's Secondary Impressions S49.9 - Unspecified injury of shoulder and upper arm
S69.9 - Unspecified injury of wrist, hand and finger(s)
S89.9 - Unspecified injury of lower leg
eSituation.13 - Initial Patient Acuity Emergent (Yellow)
eSituation.WorkRelatedGroup - Group Tag to hold patient details if the illness or injury is work related
eSituation.14 - Work-Related Illness/Injury No
eSituation.17 - Patient Activity Y93.55 - Activity, bike riding
eSituation.18 - Date/Time Last Known Well [NV = Not Recorded]
eSituation.20 - Reason for Interfacility Transfer/Medical Transport [NV = Not Applicable]
eInjury - Injury Information
eInjury.01 - Cause of Injury V18.0 - Pedal cycle driver injured in noncollision transport accident in nontraffic accident
W19 - Unspecified fall
Y29 - Contact with blunt object, undetermined intent
eInjury.02 - Mechanism of Injury Blunt
eInjury.03 - Trauma Triage Criteria (High Risk for Serious Injury) [NV = Not Recorded]
eInjury.04 - Trauma Triage Criteria (Moderate Risk for Serious Injury) [NV = Not Recorded]
eInjury.07 - Use of Occupant Safety Equipment Helmet Worn
Protective Clothing
eInjury.09 - Height of Fall (feet) 2
eArrest - Cardiac Arrest Information
eArrest.01 - Cardiac Arrest No
eArrest.02 - Cardiac Arrest Etiology [NV = Not Applicable]
eArrest.03 - Resuscitation Attempted By EMS [NV = Not Applicable]
eArrest.04 - Arrest Witnessed By [NV = Not Applicable]
eArrest.07 - AED Use Prior to EMS Arrival [NV = Not Applicable]
eArrest.09 - Type of CPR Provided [NV = Not Applicable]
eArrest.11 - First Monitored Arrest Rhythm of the Patient [NV = Not Applicable]
eArrest.12 - Any Return of Spontaneous Circulation [NV = Not Applicable]
eArrest.14 - Date/Time of Cardiac Arrest [NV = Not Applicable]
eArrest.16 - Reason CPR/Resuscitation Discontinued [NV = Not Applicable]
eArrest.17 - Cardiac Rhythm on Arrival at Destination [NV = Not Applicable]
eArrest.18 - End of EMS Cardiac Arrest Event [NV = Not Applicable]
eArrest.20 - Who First Initiated CPR [NV = Not Applicable]
eArrest.21 - Who First Applied the AED [NV = Not Applicable]
eArrest.22 - Who First Defibrillated the Patient [NV = Not Applicable]
eHistory - Patient History Information
eHistory.01 - Barriers to Patient Care Physical Barrier (Unable to Access Patient)
eHistory.06 - Medication Allergies [CodeType = RxNorm] 7052 - morphine
eHistory.08 - Medical/Surgical History [PN = None Reported]
eHistory.09 - Medical History Obtained From Patient
eHistory.ImmunizationsGroup - Group Tag to hold Immunization type and date
eHistory.10 - The Patient's Type of Immunization [Custom Value] COVID-19
eHistory.11 - Immunization Year 2023
eHistory.CurrentMedsGroup - Group Tag to hold info about patient's medication
eHistory.12 - Current Medications [PN = None Reported]
eHistory.17 - Alcohol/Drug Use Indicators [PN = None Reported]
eNarrative - Call Event Narrative
eNarrative.01 - Patient Care Report Narrative Mountain bike crash. Carried by stretcher to trailhead, then transported. Patient refused any care beyond initial assessment/vitals and cleaning wounds.
eVitals - Patient Vital Sign Information
eVitals.VitalGroup - Group Tag to hold eVitals information
eVitals.01 - Date/Time Vital Signs Taken October 5, 2023, 18:24:07 GMT-06:00
eVitals.02 - Obtained Prior to this Unit's EMS Care No
eVitals.CardiacRhythmGroup - Group Tag to hold information of the type and method used for ECG interpretation associated with the cardiac rhythm.
eVitals.03 - Cardiac Rhythm / Electrocardiography (ECG) [NV = Not Recorded]
eVitals.04 - ECG Type [NV = Not Recorded]
eVitals.05 - Method of ECG Interpretation [NV = Not Recorded]
eVitals.BloodPressureGroup - Group Tag to hold the details of patient's blood pressure.
eVitals.06 - SBP (Systolic Blood Pressure) 110
eVitals.07 - DBP (Diastolic Blood Pressure) 62
eVitals.08 - Method of Blood Pressure Measurement Cuff-Manual Auscultated
eVitals.HeartRateGroup - Group Tag to hold the details of patient's heart rate.
eVitals.10 - Heart Rate 86
eVitals.11 - Method of Heart Rate Measurement Auscultated
eVitals.12 - Pulse Oximetry [PN = Refused]
eVitals.13 - Pulse Rhythm Regular
eVitals.14 - Respiratory Rate 30
eVitals.15 - Respiratory Effort Shallow
eVitals.16 - End Tidal Carbon Dioxide (ETCO2) [NV = Not Recorded]
eVitals.18 - Blood Glucose Level [PN = Refused]
eVitals.GlasgowScoreGroup - Group Tag to hold the details of patient's glasgow scale
eVitals.19 - Glasgow Coma Score-Eye 4 - Opens Eyes spontaneously (All Age Groups)
eVitals.20 - Glasgow Coma Score-Verbal 5 - Oriented (>2 Years); Smiles, oriented to sounds, follows objects, interacts
eVitals.21 - Glasgow Coma Score-Motor 5 - Localizing pain (All Age Groups)
eVitals.22 - Glasgow Coma Score-Qualifier Initial GCS has legitimate values without interventions such as intubation and sedation
eVitals.23 - Total Glasgow Coma Score 14
eVitals.TemperatureGroup - Group Tag to hold information about patient's body temperature.
eVitals.24 - Temperature 35.2
eVitals.25 - Temperature Method Axillary
eVitals.26 - Level of Responsiveness (AVPU) Alert
eVitals.PainScaleGroup - Group Tag to hold the scale of patient's pain and the type of pain scale used.
eVitals.27 - Pain Scale Score 6
eVitals.28 - Pain Scale Type Numeric (0-10)
eVitals.StrokeScaleGroup - Group Tag to hold the results of patient's stroke scale and the type of stroke pain scale used.
eVitals.29 - Stroke Scale Score [PN = Refused]
eVitals.30 - Stroke Scale Type [NV = Not Recorded]
eVitals.31 - Reperfusion Checklist [NV = Not Recorded]
eVitals.33 - Revised Trauma Score 11
eExam - Patient Exam Information
eExam.01 - Estimated Body Weight in Kilograms 75
eExam.AssessmentGroup - Group Tag to hold assessment information
eExam.03 - Date/Time of Assessment October 5, 2023, 18:26:00 GMT-06:00
eExam.04 - Skin Assessment Cold
eExam.05 - Head Assessment Normal
eExam.06 - Face Assessment Normal
eExam.07 - Neck Assessment Normal
eExam.09 - Heart Assessment Not Done
eExam.AbdomenGroup - Group Tag to hold abdomen assessment findings information
eExam.10 - Abdominal Assessment Finding Location Generalized
eExam.11 - Abdomen Assessment Normal
eExam.12 - Pelvis/Genitourinary Assessment Abrasion
Contusion
eExam.SpineGroup - Group Tag to hold spine assessment findings information
eExam.13 - Back and Spine Assessment Finding Location Back-General
eExam.14 - Back and Spine Assessment Normal
eExam.ExtremityGroup - Group Tag to hold extremity assessment findings information
eExam.15 - Extremity Assessment Finding Location Ankle-Left
eExam.16 - Extremities Assessment Dislocation
Fracture-Closed
eExam.ExtremityGroup - Group Tag to hold extremity assessment findings information
eExam.15 - Extremity Assessment Finding Location Wrist-Left
eExam.16 - Extremities Assessment Crush Injury
eExam.ExtremityGroup - Group Tag to hold extremity assessment findings information
eExam.15 - Extremity Assessment Finding Location Arm-Whole Arm and Hand-Left
eExam.16 - Extremities Assessment Abrasion
Bleeding Controlled
Pain
Swelling
Contusion
eExam.ExtremityGroup - Group Tag to hold extremity assessment findings information
eExam.15 - Extremity Assessment Finding Location Leg-Whole Leg-Left
eExam.16 - Extremities Assessment Abrasion
Bleeding Controlled
Pain
Swelling
Contusion
eExam.EyeGroup - Group Tag to hold eye assessment findings information
eExam.17 - Eye Assessment Finding Location Bilateral
eExam.18 - Eye Assessment Dilated
eExam.LungGroup - Group Tag to hold lung assessment findings information
eExam.22 - Lung Assessment Finding Location Bilateral
eExam.23 - Lung Assessment Normal
eExam.ChestGroup - Group Tag to hold chest assessment findings information
eExam.25 - Chest Assessment Normal
eExam.19 - Mental Status Assessment Normal Baseline for Patient
eExam.20 - Neurological Assessment Normal Baseline for Patient
eExam.21 - Stroke/CVA Symptoms Resolved [NV = Not Applicable]
eProtocols - Medical Protocols Information
eProtocols.ProtocolGroup - Group Tag to hold eProtocol information
eProtocols.01 - Protocols Used General-Universal Patient Care/ Initial Patient Contact
eProtocols.02 - Protocol Age Category Adult Only
eProtocols.ProtocolGroup - Group Tag to hold eProtocol information
eProtocols.01 - Protocols Used Injury-Bleeding/ Hemorrhage Control
eProtocols.02 - Protocol Age Category General
eProtocols.ProtocolGroup - Group Tag to hold eProtocol information
eProtocols.01 - Protocols Used Injury-Extremity
eProtocols.02 - Protocol Age Category General
eMedications - Intervention Medications Information
eMedications.MedicationGroup - Group Tag to hold eMedication information
eMedications.01 - Date/Time Medication Administered [NV = Not Recorded]
eMedications.02 - Medication Administered Prior to this Unit's EMS Care [NV = Not Recorded]
eMedications.03 - Medication Administered [PN = Refused] [CodeType = RxNorm] 4337 - fentanyl
eMedications.04 - Medication Administered Route [NV = Not Recorded]
eMedications.DosageGroup - Group Tag to hold info about the medication dosage administered to the patient
eMedications.05 - Medication Dosage [NV = Not Recorded]
eMedications.06 - Medication Dosage Units [NV = Not Recorded]
eMedications.07 - Response to Medication [NV = Not Recorded]
eMedications.08 - Medication Complication [NV = Not Recorded]
eMedications.10 - Role/Type of Person Administering Medication [NV = Not Recorded]
eMedications.MedicationGroup - Group Tag to hold eMedication information
eMedications.01 - Date/Time Medication Administered [NV = Not Recorded]
eMedications.02 - Medication Administered Prior to this Unit's EMS Care [NV = Not Recorded]
eMedications.03 - Medication Administered [PN = Medication Allergy] [CodeType = RxNorm] 7052 - morphine
eMedications.04 - Medication Administered Route [NV = Not Recorded]
eMedications.DosageGroup - Group Tag to hold info about the medication dosage administered to the patient
eMedications.05 - Medication Dosage [NV = Not Recorded]
eMedications.06 - Medication Dosage Units [NV = Not Recorded]
eMedications.07 - Response to Medication [NV = Not Recorded]
eMedications.08 - Medication Complication [NV = Not Recorded]
eMedications.10 - Role/Type of Person Administering Medication [NV = Not Recorded]
eProcedures - Intervention Procedures Information
eProcedures.ProcedureGroup - Group Tag to hold eProcedures information
eProcedures.01 - Date/Time Procedure Performed October 5, 2023, 18:27:42 GMT-06:00
eProcedures.02 - Procedure Performed Prior to this Unit's EMS Care No
eProcedures.03 - Procedure 225116006 - Irrigation of wound
eProcedures.05 - Number of Procedure Attempts 3
eProcedures.06 - Procedure Successful Yes
eProcedures.07 - Procedure Complication Tachypnea
eProcedures.08 - Response to Procedure Unchanged
eProcedures.09 - Procedure Crew Members ID 589631 - Rodrigo R Romaguera
eProcedures.10 - Role/Type of Person Performing the Procedure Emergency Medical Technician (EMT)
eProcedures.11 - Procedure Authorization Protocol (Standing Order)
eProcedures.ProcedureGroup - Group Tag to hold eProcedures information
eProcedures.01 - Date/Time Procedure Performed October 5, 2023, 18:30:33 GMT-06:00
eProcedures.02 - Procedure Performed Prior to this Unit's EMS Care No
eProcedures.03 - Procedure 182531007 - Dressing of wound
eProcedures.05 - Number of Procedure Attempts 2
eProcedures.06 - Procedure Successful Yes
eProcedures.07 - Procedure Complication Bleeding
eProcedures.08 - Response to Procedure Improved
eProcedures.09 - Procedure Crew Members ID 589631 - Rodrigo R Romaguera
eProcedures.10 - Role/Type of Person Performing the Procedure Emergency Medical Technician (EMT)
eProcedures.11 - Procedure Authorization Protocol (Standing Order)
eProcedures.ProcedureGroup - Group Tag to hold eProcedures information
eProcedures.01 - Date/Time Procedure Performed October 5, 2023, 18:30:33 GMT-06:00
eProcedures.02 - Procedure Performed Prior to this Unit's EMS Care No
eProcedures.03 - Procedure 58715004 - Moving a patient to a stretcher
eProcedures.05 - Number of Procedure Attempts 1
eProcedures.06 - Procedure Successful Yes
eProcedures.07 - Procedure Complication None
eProcedures.08 - Response to Procedure Unchanged
eProcedures.09 - Procedure Crew Members ID 455258 - Declan Collin Renner
eProcedures.10 - Role/Type of Person Performing the Procedure Emergency Medical Technician (EMT)
eProcedures.11 - Procedure Authorization Protocol (Standing Order)
eProcedures.ProcedureGroup - Group Tag to hold eProcedures information
eProcedures.01 - Date/Time Procedure Performed [NV = Not Applicable]
eProcedures.02 - Procedure Performed Prior to this Unit's EMS Care [NV = Not Applicable]
eProcedures.03 - Procedure [PN = Refused] 278414003 - Pain management
eProcedures.05 - Number of Procedure Attempts [NV = Not Applicable]
eProcedures.06 - Procedure Successful [NV = Not Applicable]
eProcedures.07 - Procedure Complication [NV = Not Applicable]
eProcedures.08 - Response to Procedure [NV = Not Applicable]
eProcedures.10 - Role/Type of Person Performing the Procedure [NV = Not Applicable]
eProcedures.ProcedureGroup - Group Tag to hold eProcedures information
eProcedures.01 - Date/Time Procedure Performed [NV = Not Applicable]
eProcedures.02 - Procedure Performed Prior to this Unit's EMS Care [NV = Not Applicable]
eProcedures.03 - Procedure [PN = Refused] 79321009 - Application of splint
eProcedures.05 - Number of Procedure Attempts [NV = Not Applicable]
eProcedures.06 - Procedure Successful [NV = Not Applicable]
eProcedures.07 - Procedure Complication [NV = Not Applicable]
eProcedures.08 - Response to Procedure [NV = Not Applicable]
eProcedures.10 - Role/Type of Person Performing the Procedure [NV = Not Applicable]
eDisposition - Patient Disposition Information
eDisposition.DestinationGroup - Group Tag to hold info about the Destination and the Disposition details
eDisposition.01 - Destination/Transferred To, Name Poudre Valley Hospital
eDisposition.02 - Destination/Transferred To, Code 010305
eDisposition.03 - Destination Street Address [Value from DEMDataSet]
eDisposition.04 - Destination City [Value from DEMDataSet]
eDisposition.05 - Destination State [Value from DEMDataSet]
eDisposition.06 - Destination County [Value from DEMDataSet]
eDisposition.07 - Destination ZIP Code [Value from DEMDataSet]
eDisposition.08 - Destination Country [Value from DEMDataSet]
eDisposition.09 - Destination GPS Location [Value from DEMDataSet]
eDisposition.10 - Destination Location US National Grid Coordinates [Value from DEMDataSet]
eDisposition.11 - Number of Patients Transported in this EMS Unit 1
eDisposition.IncidentDispositionGroup - Group Tag to hold info about the incident disposition details
eDisposition.27 - Unit Disposition Patient Contact Made
eDisposition.28 - Patient Evaluation/Care Patient Evaluated and Refused Care
eDisposition.29 - Crew Disposition Back in Service, Care/Support Services Refused
eDisposition.30 - Transport Disposition Transport by This EMS Unit (This Crew Only)
eDisposition.31 - Reason for Refusal/Release Against Medical Advice
eDisposition.13 - How Patient Was Moved to Ambulance Other
Stretcher
eDisposition.14 - Position of Patient During Transport Semi-Fowlers
Supine
eDisposition.15 - How Patient Was Moved From Ambulance Stretcher
eDisposition.16 - EMS Transport Method Ground-Ambulance
eDisposition.17 - Transport Mode from Scene Emergent (Immediate Response)
eDisposition.18 - Additional Transport Mode Descriptors Intersection Navigation-With Normal Light Patterns
Speed-Normal Traffic
No Lights or Sirens
eDisposition.19 - Final Patient Acuity Emergent (Yellow)
eDisposition.20 - Reason for Choosing Destination Closest Facility
eDisposition.21 - Type of Destination Hospital-Emergency Department
eDisposition.22 - Hospital In-Patient Destination [NV = Not Applicable]
eDisposition.23 - Hospital Capability Hospital (General)
Trauma Center Level 3
eDisposition.HospitalTeamActivationGroup - Group Tag to hold info about the destination team pre-arrival activation
eDisposition.24 - Destination Team Pre-Arrival Alert or Activation Yes-Trauma (General)
eDisposition.25 - Date/Time of Destination Prearrival Alert or Activation October 5, 2023, 19:07:30 GMT-06:00
eDisposition.32 - Level of Care Provided per Protocol BLS - All Levels
eOutcome - Patient Outcome Information
eOutcome.01 - Emergency Department Disposition Admitted as an inpatient to this hospital.
eOutcome.02 - Hospital Disposition Discharged to home or self care (routine discharge)
eOutcome.EmergencyDepartmentProceduresGroup - Group Tag to hold information about emergency department procedures
eOutcome.09 - Emergency Department Procedures [NV = Not Recorded]
eOutcome.19 - Date/Time Emergency Department Procedure Performed [NV = Not Recorded]
eOutcome.10 - Emergency Department Diagnosis [NV = Not Applicable]
eOutcome.11 - Date/Time of Hospital Admission October 5, 2023, 20:24:52 GMT-06:00
eOutcome.HospitalProceduresGroup - Group Tag to hold information about hospital procedures
eOutcome.12 - Hospital Procedures 0QHK34Z - Insertion of Internal Fixation Device into Left Fibula, Percutaneous Approach
eOutcome.20 - Date/Time Hospital Procedure Performed October 6, 2023, 10:43:00 GMT-06:00
eOutcome.HospitalProceduresGroup - Group Tag to hold information about hospital procedures
eOutcome.12 - Hospital Procedures 0SQG4ZZ - Repair Left Ankle Joint, Percutaneous Endoscopic Approach
eOutcome.20 - Date/Time Hospital Procedure Performed October 6, 2023, 10:12:00 GMT-06:00
eOutcome.HospitalProceduresGroup - Group Tag to hold information about hospital procedures
eOutcome.12 - Hospital Procedures 0SSNXZZ - Reposition Left Metatarsal-Phalangeal Joint, External Approach
eOutcome.20 - Date/Time Hospital Procedure Performed October 6, 2023, 10:20:00 GMT-06:00
eOutcome.13 - Hospital Diagnosis S60.212A - Contusion of left wrist, initial encounter
S82.422A - Displaced transverse fracture of shaft of left fibula, initial encounter for closed fracture
S93.05XA - Dislocation of left ankle joint, initial encounter
V18.1XXA - Pedal cycle passenger injured in noncollision transport accident in nontraffic accident, initial encounter
eOutcome.16 - Date/Time of Hospital Discharge October 8, 2023, 12:05:03 GMT-06:00
eOutcome.18 - Date/Time of Emergency Department Admission October 5, 2023, 20:15:32 GMT-06:00
eOther - Other Miscellaneous Information
eOther.01 - Review Requested No
eOther.02 - Potential System of Care/Specialty/Registry Patient Trauma
eOther.EMSCrewMemberGroup - Group Tag to hold info about the EMS Crew Member
eOther.03 - Personal Protective Equipment Used Gloves
Mask-Surgical (Non-Fitted)
Reflective Vest
eOther.04 - EMS Professional (Crew Member) ID 455258 - Declan Collin Renner
eOther.05 - Suspected EMS Work Related Exposure, Injury, or Death No
eOther.06 - The Type of Work-Related Injury, Death or Suspected Exposure None
eOther.EMSCrewMemberGroup - Group Tag to hold info about the EMS Crew Member
eOther.03 - Personal Protective Equipment Used Gloves
Mask-Surgical (Non-Fitted)
eOther.04 - EMS Professional (Crew Member) ID 589631 - Rodrigo R Romaguera
eOther.05 - Suspected EMS Work Related Exposure, Injury, or Death Yes
eOther.06 - The Type of Work-Related Injury, Death or Suspected Exposure Injury-Lifting/Back/Musculoskeletal
eOther.08 - Crew Member Completing this Report 455258 - Declan Collin Renner
eOther.SignatureGroup - Group Tag to hold signature details
eOther.12 - Type of Person Signing EMS Crew Member (Other)
eOther.13 - Signature Reason Other
eOther.15 - Signature Status Signed
eOther.19 - Date/Time of Signature October 5, 2023, 20:13:12 GMT-06:00
eOther.20 - Signature Last Name Romaguera
eOther.21 - Signature First Name Rodrigo
eOther.SignatureGroup - Group Tag to hold signature details
eOther.12 - Type of Person Signing EMS Primary Care Provider (for this event)
eOther.13 - Signature Reason Other
eOther.15 - Signature Status Signed
eOther.19 - Date/Time of Signature October 5, 2023, 20:13:30 GMT-06:00
eOther.20 - Signature Last Name Renner
eOther.21 - Signature First Name Declan
eOther.SignatureGroup - Group Tag to hold signature details
eOther.12 - Type of Person Signing Patient
eOther.13 - Signature Reason HIPAA acknowledgement/Release
Refusal of Care
Permission to Transport
eOther.14 - Type Of Patient Representative Self
eOther.15 - Signature Status Signed
eOther.16 - Signature File Name refusal-EMS2.png
eOther.17 - Signature File Type image/png
eOther.18 - Signature Graphic
eOther.19 - Date/Time of Signature October 5, 2023, 19:02:23 GMT-06:00
eOther.20 - Signature Last Name Bayer
eOther.21 - Signature First Name Brock