“Garbage in, garbage out,” or GIGO, was first presented to me by an information systems professor as I struggled to learn the nuances of emerging technology. I was wrestling with the task of transitioning the department and its information system from typewriters and mimeographs to powerful and magical 8084 computers that would once and for all resolve the manual tasks of data compilation, interpretation and presentation.

Seventeen years and about a quadrillion megabytes have gone by since that first foray into the realm of electronic word processing, spreadsheets and standardized incident reporting, and yet that professor's remarks still echo in my mind. Why? Because the fire service has yet to realize the true potential of collecting data electronically and processing it into meaningful, useful information.

As a chief officer, I've often been frustrated with the multiplicity of requirements for standardized reporting. Not only are we entrenched with the notion that reporting every facet of minutiae is essential, but after being required to report to multiple external entities, we often find that our work ends up lost in another agency's bureaucracy.

Our employees are frustrated with the complexities of data entry and the duplication often required as a result of separate databases and reporting requirements for fire and EMS. Software vendors are frustrated with the numerous revisions to programs mandated by various regulatory bodies — and yet we still can't capture the simplest information in aggregate form.

While we've made some strides, the fire service still doesn't have a true national incident reporting system that adequately captures the scope of our daily activities. Recent headlines regarding the National Fire Incident Reporting System highlight these shortcomings.

While there will be plenty of finger-pointing, as an industry we should take the opportunity to reform our current way of doing business. As the lead national fire agency, the U.S. Fire Administration is uniquely positioned to take a leadership role in effecting change and should begin to discharge its responsibility for fire service data collection by establishing a task force to address this issue. Specifically, the USFA should learn from the National Highway Traffic Safety Administration.

Recognizing the need for a standard prehospital patient-care record, NHTSA in 1993 began to lay the foundation by undertaking the development of a uniform set of data elements. With this goal in mind, NHTSA assembled various stakeholders, including end-users, software developers, system administrators and regulatory representatives. Before finalizing this undertaking, a conference was held with industry representatives to gain further input.

Of the 80-plus elements developed, some were identified as essential and others desirable. It was recognized early on that the value of a nationally uniform set of data elements for use in prehospital-care records, and the reliability of the information itself, would ultimately depend on the individual paramedic or emt completing the record.

There was significant debate as members of the group argued for or against the inclusion of specific data elements. In the end, decisions regarding the data elements were based on the ability of the end-user (paramedic or EMT) to be objective in selecting the appropriate entry into the patient-care record.

A case in point was the argument over capturing the exact time points of patient interventions, such as when contact is made with the patient, the point at which the first and subsequent defibrillation attempts are made, and the point at which each medication is administered. While this information may have value, the question is whether it will be accurate.

Can we really expect field providers to capture these intervals with any accuracy? Or can we accept the reality that these times are subjective estimates based, at best, on the agency's recording capability? The final decision rested on the recognition that if we can't expect valid data, why should we mandate the collection of such data and what purpose would it serve if it couldn't be validated?

In creating a uniform format, NHTSA recognized that at some point linkages could be established with other organizations and databases from which information on prehospital activities could be compared. Uniform definitions and a data dictionary that meet the requirements for future comparative analysis are coming to fruition.

In an NHTSA-sponsored effort called Codes 2001, prehospital-care records are being linked to patient discharge records and crash injury reports in an effort to determine whether our patient-care efforts have a direct bearing on patient outcomes. This is a monumental step from that first meeting eight years ago, and one from which the fire service should take its cue.

From an EMS perspective, the fire service is uniquely positioned, in its role as first responders and patient transport providers, to establish the largest and most comprehensive prehospital record database. No other entity can use its collective resources in aggregating patient-care information that may well provide the basis for sound national research, planning and educational efforts.

This doesn't require reinventing the wheel, but simply including existing formats into a national fire service reporting system. As an industry, we should be able to answer basic questions regarding our level of activities, such as how many cardiac arrests did we respond to; how many times did our personnel respond to an emergency in a residence or on a street or state or federal highway; how many vehicle accidents occur on which we deploy firefighters and EMTs; what is our true response time? These are simple questions that we nonetheless can't answer from a national perspective.

I'm reminded of Ron Coleman's observation that, unlike our brethren in law enforcement, we've historically not placed great value on report writing as an essential skill. As chief officers, it's our responsibility to ensure that our work force is capable of documenting our operational activities, so we can better plan and prepare our organizations for the responsibilities we're charged with.

At the same time, however, we must make available to our personnel a system that isn't complex and doesn't require subjective interpretation or confusing possibilities when they complete an incident report. We must eliminate the duplication required of our personnel and agencies in reporting activities separately to individual regulatory agencies.

Also, we must recognize the need for reporting activities from an inclusive rather than an exclusive perspective. Since we can no longer argue that our job is solely focused on the traditional role of firefighting, we should strive to ensure that all activities are accurately documented, if for no other reason than to protect our employees from litigation.

We should take the opportunity before us and restructure our data-collection efforts. We need a system that

• allows local flexibility,
• doesn't require our personnel to have a degree in computer science to complete an incident report,
• allows agencies to use a single incident reporting system for all of our activities,
• permits the transmission of subsets of data to the appropriate agencies,
• allows for comparative analysis and
• can provide a composite of our activities from which national programmatic decisions can be made.

If we can establish a uniform set of 80 data elements to record patient-care activities, we can certainly develop a uniform set of fire service data elements that reflect our operational activities in a cohesive and defensible manner.

The efforts expended in such a comprehensive undertaking will benefit all parties concerned and, most importantly, provide a needed management tool to evaluate service delivery, analyze data components and assist in the strategic-planning process. As a result, the fire service could claim authorship of a new term: fivo, “fact in, value out.”

Where are all the EMS reports?

Data provided to Fire Chief in connection with the Fire Service Activity Survey suggest that many departments aren't filling out incident reports for their ems runs. This can be inferred from the fact that although departments tell us that 80% of their calls are ems runs, the survey of actual incident reporting data shows less than 50% reported.

The U.S. fire experience in 2000

Incident type (NFIRS designation)	Percentage of calls
100 Series - Fire	15.93%
200 Series - Explosion	0.38%
300 Series - Rescue & EMS	47.46%
400 Series - Hazardous Conditions (No Fire)	8.99%
500 Series - Service Call	7.17%
600 Series - Good Intent Call	8.21%
700 Series - False Alarm & False Call	10.30%
800 Series - Severe Weather & Natural Disaster	0.41%
900 Series - Special Type	1.14%