Pre-Hospital Care Data - PCNASP Awardee -EMS respondents

Paul Coverdell National Acute Stroke Program (PCNASP) Reporting System

Pre hospital data elements_010720_clean

Pre-Hospital Care Data - PCNASP Awardee -EMS respondents

OMB: 0920-1108

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DRAFT Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx


Instructions for Paul Coverdell National Acute Stroke Program (PCNASP) Pre-Hospital Data Elements


Public reporting of this collection of information is estimated to average xx minutes/hours per response, including the time for reviewing instructions and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (xxxx-xxxx)

EMS Agency

<EMSName>

What is the EMS Agency Name

Text, 100 characters


Provide unique identifier for EMS agency

*In GWTG the character limit for this text field may be less than the CDC character length

Required

<EMSNameU>

EMS agency name is unknown


1- Yes; 0- No


Required

Run Sheet Number

<EMSRunNo>

What is the run sheet number given to the hospital?

Text, 100 characters


 *In GWTG the character limit for this text field may be less than the CDC character length

Required

<EMSRuNoU>

EMS run sheet number is unknown


1- Yes; 0- No


Required

Scene Arrival

<ScnArrD>




_ _/ _ _/ _ _ _ _

Date MMDDYYYY

 

Optional

<ScnArDND>

Scene arrival date not documented


1 – Yes; 0 – No


Optional

<ScnArrT>


___: ____

Time HHMM

 

Optional

<ScnArTND>

Scene arrival time not documented


1 – Yes; 0 – No


Optional

Arrives at Patient

(NOTE: this item is provided secondary to scene arrival times; both can be provided if available)

<FstMdCtD>


_ _/ _ _/ _ _ _ _

Date MMDDYYYY

Time HHMM


Optional

<FstMdCtT>


___: ____

Optional

Scene Departure

<ScnDptD>


_ _/ _ _/ _ _ _ _

Date MMDDYYYY

 

Optional

<ScnDpDND>

Scene departure date not documented


1 – Yes; 0 - No


Optional

<ScnDptT>


___: ____

Time HHMM

 

Optional

<ScnDpTND>

Scene departure time not documented


1 – Yes; 0 - No


Optional

Hospital Arrival

<HospArrD>


_ _/ _ _/ _ _ _ _

Date MMDDYYYY

 *In GWTG this variable will be prepopulated from in-hospital ED triage date and time as of Winter release 2018

Optional

<ArrDDND>

Hospital arrival date not documented


1 – Yes; 0 - No


Optional

<HospArrT>


___: ____

Time HHMM

 

Optional

<ArrDTND>

Hospital arrival time not documented


1 – Yes; 0 – No


Optional

Patient Age

<Age>

Age |__|__|__| years

Numeric ### = 3-digit

0 < age < 125

 

Required

Patient Gender

<Gender>

Gender

Numeric # = 1-digit

1 - Male; 2 - Female; 3 - Unknown

Select only 1 gender

Required

EMS Transfer

<Transfer>

Was this an interfacility transport or transfer patient?


1 - Yes; 0 – No; 2 - Unknown

 

Required

EMS Diagnosis Impression

<EMSDiagn>

Did EMS think this was a possible stroke? (i.e., primary or secondary provider impression)

Numeric # = 1-digit

1 - Yes; 2 - No; 3- not documented

 

Required

Hospital pre-notification Performed

<EMSPreNt>

Did EMS call the hospital to notify them of a possible stroke patient?

Numeric # = 1-digit

1 - Yes; 2 – No; 3- N/A

 

Required

<EMSAlert>

Was additional information provided as part of pre-notification?

Numeric # = 1-digit

1 – Blood glucose value; 2 – Blood pressure; 3 – Result of stroke screen/Severity score; 4 – LKW time per EMS; 5 – Seizure activity

*In GWTG this ems_alert is not enabled if gs_prehosp_ems is NO[1]

Optional

Pre-hospital stroke screen performed

<StkScn>

Did EMS perform a pre-hospital stroke screen?

Numeric # = 1-digit

1 - Yes; 2– No; 3 – Not documented

 

Required

<ScnType>

What type of stroke screen tool did EMS preform?


14=BE FAST; 4=CPSS; 5=DPSS; 6=FAST; 8=MASS; 9=Med PACS; 15=MEND; 10=mLAPSS; 7=LAPSS 11=OPSST; 12=ROSIER; 13=Other (text field for other); 1=Stroke screen tool used, but tool used is unknown; 2=No stroke screen used; 13=Not Documented

*CDC format originally aligned with NEMSIS; since GWTG allows “other” category, we will adopt this format. 

Optional

<ScrTyUnk>

If other, please specify

Text 50 characters



Optional

<ScnReslt>



1- Positive; 2- Negative; 3- Not documented;


Optional

<SevType>

If stroke severity scale used, what type of scale did EMS perform?


1=CPSSS/CSTAT; 2=FAST ED; 3=LAMS; 5=RACE; 6=Other (text field for other) ems_sevscaleot; 7 = Severity scale used, but tool used is unknown; 8 = No severity scale used; 9= Not Documented


Optional

<SevTyUnk>

If other, please specify

Text 50 characters



Optional

<SevScore>


Numeric # = 2-digit



Optional

Last Known Well

<ELKWD>


_ _/ _ _/ _ _ _ _

Date MMDDYYYY

CDC: Leave blank if unknown or did not ask


Required

<ELKWDND>

LKW date not documented


1- Yes; 0- No

Required

<ELKWT>


___: ____

Time HHMM

Required

<ELKWTND>

LKW time not documented


1- Yes; 0- No

Required

Time of Onset

<OnsetD>


_ _/ _ _/ _ _ _ _

Date MMDDYYYY

Optional

<OnsetDND>

Onset date not documented


1- Yes; 0- No

Optional

<OnsetT>


___: ____

Time HHMM

Optional

<OnsetTND>

Onset time not documented


1- Yes; 0- No

Optional

Thrombolytic Checklist

<tPAChk>

Was a thrombolytic checklist done for possible alteplase eligibility?

Numeric # = 1-digit

1 - Yes; 0 - No/ND

 

Optional

Glucose Checked

<GluChk>

Was glucose checked?

Numeric # = 3-digit

1 - Yes; 0 – No; 2- glucometer not available; 3- not documented/ not required to perform; 4-patient refused

 


Required

<EMSGlu>

Glucose level

Numeric # = 3-digit


*GWTG: mg/dL; for glucometers that don’t produce a numeric value enter 600 for high and 20 for low

Required

<BglVal>

Blood glucose value

Numeric # = 1-digit

1 – Too high; 2- Too low


Optional

Destination Decision

<DestDscn>

How did EMS make the decision to come to this hospital?

Numeric # = 1-digit

1 = Protocol to nearest stroke center; 2 = protocol to nearest hospital; 3 = patient/family choice; 4 = enroute medical direction; 5 = nearest hospital; 6 = other; 7- unknown/not documented


Optional

<DesDscnO>

If other reason, specify

Text, 200 characters



Optional

Follow-up

<EMSFU>

Did EMS receive hospital follow-up

Numeric # 1-digit

1 = Yes; 0 = No

 

Optional

<DiAgree>

If yes, did EMS diagnosis of a stroke agree with hospital diagnosis?

Numeric # 1-digit

1 = EMS & Hospital both diagnosed a stroke; 2 = EMS called a stroke and Hospital did not diagnose a stroke; 3 = EMS did not call a stroke and Hospital diagnosed a stroke

 

Optional

Hospital Coverdell Participation

<HospCovd>

Is this patient transport to a hospital participating in the Coverdell program? (yes/no)

Numeric # =1-digit

0 = No; 1 = Yes; 2 = Unknown


Required

EMS Coverdell Participation

<EMSCovd>

Is this patient transport by an EMS agency participating in the Coverdell program?  (yes/no)

Numeric # =1-digit

0 = No; 1 = Yes; 2 = Unknown


Required

NOTES on pre-hospital elements (Updated 11/19/17):

- EMSName should be a unique identifier, not the actual name of the EMS agency, which must fit within character limit. Ensure no duplicate identifiers occur.

- EMSRunNo - use the same sequence of numbers for every run sheet if truncating. For instance, you could choose the last 7 digits or first 5 digits, as long as they are unique and will not create duplicates. In the long run, it would be best if the names can be standardized which will help analyzing in the future. Ensure no duplicates occur.

- All states are required to report the “Additional Data Elements” (i.e., listed in section 4.4.3 of the Coverdell Resource Guide) as part of each dataset – pre-hospital, in-hospital, and post-hospital. These three additional elements -- <statenam>, <hospital> and/or <EMSName>, and <patidnum> are needed to support record auditing and analysis.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorOdom, Erika C. (CDC/ONDIEH/NCCDPHP)
File Modified0000-00-00
File Created2021-01-14

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