Emergency Medical Services (EMS) Data and it’s utility for Public Health Surveillance

1. Emergency Medical Services (EMS) Data and it’s utility forPublic Health Surveillance Todd StoutPresident, FirstWatch tstout@firstwatch.net 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 “7-digit” Nonemergency Primary Public SafetyAnswering Point (PSAP) “Police, Fire or Medical?” Secondary Public SafetyAnswering 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 • 9-1-1 telephone calls • 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 (www.EmergencyDispatch.org) • 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 (www.nemsis.org) • 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 * 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 ParamedicineakaMobile 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 tstout@firstwatch.net