Retrieving and Refiling Records - Public Agencies

Attachment D

SUDORS Data Elements

There are no standard paper data collection forms to be used by participating health departments because the health departments will be abstracting information from electronic or paper vital statistics or medical examiner or coroner (ME/C) records into the National Violent Death Reporting System (NVDRS) web-based data system. This is a list of data elements that the 52 public health departments participating in SUDORS (50 states, District of Columbia, and Puerto Rico) must abstract. Specifically, participating health departments must abstract from death certificates and ME/C reports: 1) key injury data elements and toxicology findings (See Table 1) and 2) data elements that describe circumstances specific to drug overdose deaths (See Table 2). There are a few data elements marked optional that participating health department may or may not choose to collect.

Table 1: SUDORS key injury and toxicology data elements

Incident information Incident type Case status: Incident follow-up or complete Number of source documents in incident (Optional) Number of persons in incident Number of weapons in incident Date supervisor checked incident (Optional) Date supervisor rechecked incident (Optional) Narrative of the incident Data sources used for case abstraction (Optional) Abstractor name (Optional) Document notes Document type (Optional) Source agency requested from (Optional) Date record requested (Optional) Date record re-requested (Optional) Date record received (Optional) Date record abstracted/imported (Optional) Date entered data checked (Optional) Document determined to be unavailable (Optional) Document notes field (Optional) Victim information Abstractor assigned manner of death Manner of death on death certificate Manner of death per coroner/medical examiner Person type Age Age unit Sex White Black or African American Asian Native Hawaiian or Pacific Islander American Indian or Alaskan Native Unspecified Race Hispanic/Latino/Spanish Country of residence State of residence County of residence City of residence Zip code of residence US Census block group of residence (Optional) US Census tract of residence (Optional) Birth state, territory, or country Birth country, if other Current or former military personnel Marital status Relationship status Sex of partner Victim was pregnant Place of death Place of death, if other Date pronounced dead

Victim information (Continued) Date of death State or territory of death Immediate cause of death text Cause leading to immediate cause text Next antecedent cause of death text Underlying cause of death text Underlying cause of death ICD-10 code ICD10 4th (character) ICD10 5th (character) Autopsy performed State or territory where injury occurred County where injury occurred (FIPS code) City where injury occurred (FIPS code) Date of injury Time of injury Type of location where injured Injured at work Injured at victim’s home US Census block group of injury (Optional) US Census tract of injury (Optional) Survival time no. of units Unit of time used in survival time Education by degree Number years of education Usual occupation code Usual occupation text Current occupation text Kind of business/industry code Usual industry text Multiple conditions cause of death codes on death certificate 1-10 Height Weight Transgender Sexual orientation Recent release from an institution ZIP code of injury EMS at scene Homeless status Current occupation Victim in custody when injured Toxicology Toxicology information unavailable Date specimens were collected Time specimens were collected Name of substance Category of substance (Automatically generated) Code for substance (Automatically generated) Toxicologic test performed to detect the substance Results of toxicologic test for the substance Substance contributed to death Person for whom substance was prescribed

Table 1: SUDORS key injury and toxicology data elements (continued)

Summary toxicology Testing for alcohol Alcohol test results Blood alcohol concentration results Testing for amphetamines Amphetamine test results Testing for antidepressants Antidepressant test results Testing for cocaine Cocaine test results Testing for marijuana Marijuana test results Testing for opiate(s) Opiate test results Testing for anticonvulsants Anticonvulsants test results Testing for antipsychotic Antipsychotic test results Testing for barbiturates Barbiturates test results Testing for benzodiazepines Benzodiazepines test results Testing for muscle relaxants Muscle relaxants test result Testing for carbon monoxide Carbon monoxide results Carbon monoxide source, if present Toxicology Comment Hospital information Victim seen in ED Victim admitted to inpatient care First external cause of injury code from hospital (Optional) Second external cause of injury code from hospital (Optional)

Suicide and undetermined intent circumstance variables that can be completed for unintentional or undetermined intent drug overdose deaths (*Indicates crisis information collected with a checkbox) Circumstances available from Coroner/Medical Examiner Current depressed mood Current diagnosed mental health problem* Type of first mental illness diagnosed Type of second mental illness diagnosed Other mental health diagnosis Current mental health/substance abuse treatment Ever treated for mental health or substance abuse problem Alcohol problem* Alcohol use suspected when injured Other substance abuse problem* Other addiction* Person left a suicide note Recently disclosed suicidal thoughts/plans Disclosed suicidal intent to whom History of suicide attempts History of expressed suicidal thoughts or plans Suicide of friend or family (Optional)*^ Other crisis in past two weeks or upcoming two weeks Non-suicide death of friend or family (Optional)*^ Contributing physical health problem (Optional)*^ Intimate partner violence (Optional)*^ Intimate partner problem (Optional)*^ Family relationship problem (Optional)*^ Other relationship problem (Optional)*^ Job problem (Optional)*^ School problem (Optional)*^ Financial problem (Optional)*^ Contributing criminal legal problem (Optional)*^ Civil legal problems (Optional)*^ Previous perpetrator of violence in the past month (Optional)^ Previous victim of violence in the past month (Optional)^ Anniversary of a traumatic event (Optional)^ History of abuse or neglect as a child (Optional)^ Eviction/loss of home (Optional)*^ Physical fight (2 people) (Optional)^ Argument (Optional)^ Timing of most recent argument (Optional)^ Disaster exposure (Optional)^

^Recipients also funded by the National Violent Death Reporting System (CDC-RFA-CE18-1804) are required to collect additional circumstance data elements (listed as optional in the table) as well as law enforcement data elements (not listed in table) on drug overdose deaths of undetermined intent. While these data are not required as part of SUDORS, these data will be shared with the CDC SUDORS team.

Table 2: Unique SUDORS data elements collected on drug overdose deaths

Type of drug poisoning SUDORS case Type of drug poisoning Date last known alive before overdose Time last known alive before overdose Substance abuse Previous drug overdose History of prescription opioid/heroin abuse Recent opioid use relapse Recent emergency department visit Treatment for substance abuse Inpatient/outpatient rehabilitation Medication-assisted treatment, or MAT (with cognitive/behavioral therapy) Medication-assisted treatment, or MAT (without cognitive/behavioral therapy) Medication-assisted treatment, or MAT (cognitive/behavioral therapy unknown)# Cognitive/behavioral therapy Narcotics Anonymous Other type of substance abuse treatment Scene indications of drug abuse Any evidence of drug use at scene No evidence of drug use Evidence of rapid overdose Tourniquet around arm Body position consistent with rapid overdose Needle location Witness report of rapid overdose Other evidence of rapid overdose No information on route of administration Evidence of injection drug use Track marks on victim Needles/syringes at scene Tourniquet at scene Filters at scene Cookers at scene Witness report of injection drug use Other evidence of injection drug use Evidence of snorting/sniffing Evidence of smoking Evidence of transdermal exposure Evidence of ingestion Evidence of suppository Evidence of sublingual Evidence of buccal Evidence of prescription drug use Prescription drug(s) prescribed to victim Prescription drug(s) not prescribed to victim Prescription drug(s) with unknown prescription Evidence of prescription drugs at scene Pills/tablets at scene Patch at scene Prescription bottle at scene

Scene indications of drug abuse (continued) Evidence of prescription drugs at scene (continued) Liquid at scene Lozenges/lollipops at scene Prescription vial at scene Witness report of prescription drug use Other evidence of prescription drug use Evidence of use of prescription fentanyl at scene or by witness report Evidence of illicit drug use Powder at scene Witness report of illicit drug use Counterfeit pills at scene Tar at scene Crystal at scene Evidence of illicit drug packaging Other illicit drug evidence Response to drug overdose Naloxone administered Unknown whether naloxone administered Naloxone not administered Total number of naloxone doses by first responders/health care Total number of naloxone doses by lay-person(s) Naloxone administered by unknown Naloxone administered by law enforcement Naloxone administered by EMS/fire Naloxone administered by hospital (ED/inpatient) Naloxone administered by other source Naloxone administered by lay-person Lay-person was person using drugs Lay-person was intimate partner Lay-person was friend Lay-person was other family Lay-person was roommate Lay-person was a stranger Other type of lay-person Drug use witnessed Bystander present at overdoses Person using drugs present as bystander Intimate partner present as bystander Other family present as bystander Friend present as bystander Stranger present as bystander Roommate present as bystander Medical professional present as bystander Other type of bystander present Bystander response other than naloxone CPR performed during bystander response Rescue breathing during bystander response Sternal rub during bystander response Stimulation during bystander response Other type of bystander response

Table 2 Unique SUDORS data elements collected on drug overdose deaths (continued)

Response to drug overdose (continued) Reasons for no or delayed response to overdose Bystander did not recognize any abnormalities Bystander was using and impaired Public space and strangers didn’t intervene Bystander reported abnormalities but did not recognize as overdose Bystander spatially separated (i.e., different room) Bystander was unaware that decedent was using drugs No response-other Presence of pulse on first-responder arrival First responders responses excluding administering naloxone CPR Rescue breathing Epinephrine administered Transport to ED performed Provided oxygen Other first-responder intervention Presence of a pulse on arrival of first responders

Medical history COPD (Chronic Obstructive pulmonary disease) Asthma Sleep apnea Other breathing problem Heart disease Obesity Hepatitis C HIV/AIDS History of major injury Treated for pain at time of injury Migraine Back pain Other chronic pain Prescription information Use of prescription morphine Prescription morphine narrative Prescribed buprenorphine/methadone Prescribed fentanyl Number of opioid prescriptions in 30 days preceding injury (Optional) Number of pharmacies dispensing opioids to decedent in 180 days preceding injury (Optional) Number of doctors writing opioid prescriptions to the decedent in the 180 days preceding injury (Optional)

5