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

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

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

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.”

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.”

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.”

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.”

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

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

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

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)

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)

9-1-1 Telephone data example Landline Wireless

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

ProQA data example – p1

ProQA data example – p2

ProQA data example – p3

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

Dispatch System Example – p1

Dispatch System Example – p1

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

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)

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

ePCR Data Example – p1

ePCR Data Example – p2

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

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…

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…

Thank You & Contact Info Todd Stout tstout@firstwatch.net