1. Todd Stout President, FirstWatch
Emergency Medical Services (EMS) Data and it’s utility for Public Health Surveillance
Todd Stout President, FirstWatch
ISDS Preconference 12/11/2013 Track 1

2. Take-aways about EMS data
Not necessarily a ‘novel use’ any more
Types & benefits of EMS data sources
Examples of uses in public health
Future of EMS & how it affects you

3. My background Former paramedic & EMS manager
Developed the FirstWatch system in 1999 for KCMO
Monitor 52,000 public safety records per day in real time
Serve 130 communities w/80 million people (US & Canada)
Get data from 50+ types of EMS data systems
Involved with ISDS for years

4. EMS data demonstrated value
“Monitoring EMS logs can enhance detection of travelers with serious infections at POEs but requires additional screening and follow-up by CDC.”

5. EMS data demonstrated value
More from that report: “Use of EMS dispatch and response and emergency department chief complaint data is an efficient way to detect conditions of clinical and public health interest.” “The results of this study suggest that automated surveillance of EMS logs can enhance detection of reportable infections at POEs and supplement existing public health surveillance.”

6. EMS data demonstrated value
More from that report: “Although the use of EMS data in the early detection of reportable infectious diseases has not been studied previously, EMS data have been found to be a useful means for real-time syndromic surveillance for early detection of outbreaks and specific health conditions.”

7. EMS data demonstrated value
September 2011 “It is a useful supplement to ESSENCE and the use of these two systems together provides a more comprehensive look at both pre-hospital and ED data for all of Pinellas County.”

8. EMS data demonstrated value
San Diego Hospital vs. EMS Dispatch data
Anecdotal Visual Comparison Example

9. EMS data sources Telephone 9-1-1, 7-digit (emergency & nonemergency)
Call-taking (EMD) & dispatch
ProQA or other call-taking processes
Dispatch & resource management
ePCR and/or RMS
Electronic Patient Care Records
Record Management System

10. EMS Data Flow 9-1-1 Landline 9-1-1 Wireless “7-digit” Emergency
Nonemergency
Primary Public Safety Answering Point (PSAP)
“Police, Fire or Medical?”
Secondary Public Safety Answering Point (PSAP)
Call-taking & dispatching data
electronic Patient Care Record (ePCR)
Clinical Data
Records Management (RMS)
Incident Data – less Clinical

11. Telephone / Calls for Help
Landline
Cellular
Primary PSAP
“Police, Fire or Medical?”
“7-digit” access
Emergency calls
Nonemergency calls
VOIP (Vonage, Magic Jack, etc.)
SMS, Text, Video, etc. (rare)

12. Telephone / Calls for Help
Limited data set, but increasingly available
Location can be misleading, if available
Normal to have multiple calls for single incident
Some good research done
(UCSD San Diego Super Computer Center)

13. 9-1-1 Telephone data example
Landline
Wireless

14. Secondary PSAP Sources
Call-taking data approaches
Unstructured process, or
Structured process, usually locally developed, or
Standardized process
International Standard (
3,200+ Communications Centers around the world use this international standard system (ProQA)
Can be available as soon as call-taking is ended

15. ProQA data example – p1

16. ProQA data example – p2

17. ProQA data example – p3

18. Computer-Aided-Dispatch
Incident & response data
Chief Complaint
Call & Unit Times
Origin and Destination (Lats/Lons)
Narrative (free text)
Resource management data
Unit availability, Hospital system activity
Many different software systems
Can be available in real time, as call in progress

19. Dispatch System Example – p1

20. Dispatch System Example – p1

21. Patient Care Data Records Management Systems
Traditional & Fire or Police-Based
Typically less patient care oriented
Paper / scanned forms
Billing system data
ICD9

22. Patient Care Data ePCR Electronic Patient Care Record / Report
Usually very medical / clinical
Increasingly used
Evolving systems
High software turnover rate
Very limited standardization
Rarely linked to hospital data (so far)

23. Patient Care Data ePCR Output Application-specific
Often information rich, but non-standard
Usually available at end of call or end of shift
NEMSIS (
National EMS Information System
Usually available weekly, monthly, some next day
Transitioning to HL7 integration
Many State variations of NEMSIS

24. ePCR Data Example – p1

25. ePCR Data Example – p2

26. EMS data source comparison
9-1-1 Primary PSAP
Dispatch Secondary PSAP
Emergency Medical Dispatch
Electronic
Patient Care Record
Initial patient complaint X
Medic impression(s)
Near-Real-Time*
Location ?
Transport info
Pt. Assessment
Past Medical Hx
Treatment/Meds
* Within a few minutes – while the call is occurring

27. EMS data uses by Public Health
ILI monitoring (RIN)
Situational Awareness (BioWatch)
Biosurveillance
Large special events (Mardi Gras, Super Bowl)
Overdoses, drug usage, addiction
Drowning prevention
Asthma
Environmental (heat & cold)
Natural & man-made disasters…

28. Future of EMS… Increasingly outcome & research oriented
Likely more involved in community health
Community Paramedicine aka Mobile Integrated Healthcare
Already having impact on patient usage of ERs
Many sites including some pioneers:
San Diego, Ft. Worth, Pittsburgh, Raleigh, Eagle Colorado, San Diego, Maine, Reno, Tucson, Toronto, Nova Scotia, Winnipeg…

29. Thank You & Contact Info
Todd Stout