Linking Dispatch, Paramedic, Hospital, and Regional Planning Data in Portland, Oregon: Christopher Bangs, MS Department of Emergency Medicine, Oregon Health & Science University Portland, Oregon Geospatial Analysis of Traffic-Related Injury Data

The Annual Toll of Traffic-Related Injury in the USA and Oregon  On an average, each year in the USA Millions are injured in motor vehicle crashes. 42,000 persons die.  On an average, each year in Oregon There are 5,000+ hospitalizations for motor vehicle trauma persons die. (sources: NHTSA, NSC, CDC, ODOT, Oregon EMS, Oregon Trauma Registry)

 We propose to link non-traditional data sources with traffic-related injury data to provide an improved understanding of the causes, consequences, and social implications of injury as a public health problem in the Portland, Oregon metropolitan region.  We developed a geocoded dataset to link these datasets, and provide a foundation for spatial analysis. Scope of the project:

Primary Data Source (TCC):  TCC staff verify injury incident location by contacting either paramedic or Bureau of Emergency Communications during the same shift, and are trained in geocoding methods.  Geocoding began on April 1,  Address match rate = ~95% with manual correction, using the Oregon Trauma Band Number (placed on patient in the field). Area Trauma communications center - regional trauma system data

Primary Data Source (METRO RLIS):  Metro regional government is a directly-elected regional authority serving the Portland tri-county region.  Similar to metropolitan planning organization.  Maps include street networks, county, flood plain maps, traffic analysis zones, planning zones, and USGS topographic maps, geocoded and current for the region. Metropolitan regional land use information systems data

Other Data Sources  Multnomah County EMS trauma data (subset of Oregon Trauma Registry)  Portland police neighborhood crime data [CRIME]  Oregon and OHSU Trauma Registries  Hospital emergency department information system

Methods  Retrospective, population & incidence studies with spatiotemporal analyses  OHSU houses the TCC data repository.  TCC staff require the assignment of trauma band number by the prehospital provider if they are missing or duplicated by first responders in the field.

Methods  Focused population of interest, with goal to link related but previously unlinked data sets.  TCC data are the primary source of injury data for the analysis (points).  METRO Regional Land Information System provides base mapping information for area of study - aggregate data by neighborhood, TAZs (polygons).  CRIME data was aggregated on neighborhood samples.

Trauma Band Number Pre-Hospital Chart Trauma Communications Record EDIS / Hospital Charts OTR 911 Dispatch Data Neighborhood Crime Data

Area of Study: Portland, Oregon metropolitan area Regional Trauma System Map 1

Findings: All Traumas ( ) Map 2

Map 3

Limitations of Linking Datasets  Common trauma registry limitations - missing data, retrospective data, addresses are incomplete/incorrect.  Descriptive maps based upon both points and aggregations.  Crime data were incomplete, so sampling was required.  Agencies use different operational and field definitions for data points and variables.

Strengths and Unique Considerations  The Oregon trauma band number links disparate datasets  METRO RLIS neighborhood base maps  EMS data repository for dispatch, trauma, cardiac and hospital outcome data  Census, police, planning, and other Oregon agency databases are embracing GIScience  OHSU houses national ED electronic surveillance projects (CDC EMERGE ID NET)

Linking medical databases for optimal patient care and population studies – potentialities  “The Australian government…is creating a Master Person Index to allow its socialized health care system to identify and access the medical records of any citizen brought to a hospital for treatment. This is not a single monolithic database but rather the creation of an index that involves linking and integrating the many hospital-patient databases…”  Ephraim Schwartz in INFOWorld Sept. 24, 2001

Conclusions  Accurate and precise base maps are critical.  Creation of a common link in the identifier dataset is critical to linking both traditional and non-traditional databases.  Spatial data do not correlate with medical outcome data; a linking mechanism is required.  Disparate datasets can communicate and enhance our understanding of the injury problem.  Collaboration among organizations provides opportunity to expand knowledge and extend resources to study public health issues.

Research is Promising: The Now and Future  Spatiotemporal variations in traffic injury  Spatiotemporial aspects of EMS services, based on trauma activity  Proximity of injury to destinations, types of businesses, parks, etc.  Oregon trauma band number utilization and outcome data  EMS injury surveillance system, linking traffic injury, SES, planning, social and crime data