Fire departments have been in existence for years. They not only respond to various types of fire incidents, inspect buildings, and protect the public through education and training, but they also provide emergency medical care to patients. How they perform such care varies across the nation. For example, some fire departments only provide extrication services while others function solely as first responders. Still others act as the EMS agency by assessing, treating, and transporting the patient.

Just as the documentation of fire incidents is important to a fire department, so is the accurate documentation of EMS activations. Every detail related to the EMS response — from times, location, patient assessment, and treatment — is critical. Not only is this information valuable concerning the individual electronic patient care record (ePCR), but also by providing vital information for generating agency/department statistics.

What is NEMSIS?

The National EMS Information System (NEMSIS) is the national repository of all 911-initiated EMS activations in the United States. In addition, medical transport, interfacility, mutual-aid and intercept calls are submitted via statewide data-collection systems to NEMSIS. Currently, 28 states and territories submit clinical data related to EMS activations and demographic information characterizing the responding agencies. The creation of NEMSIS allowed for the standardization of pre-hospital data collection, similar to what the National Fire Incident Reporting System (NFIRS) has done for fire incidents.

A subset of the national EMS standard dataset is submitted to NEMSIS, aggregated, and made available to the public via static reports or an OLAP data cube, the latter of which enables faster processing of the information. Using these data, the NEMSIS Technical Assistance Center (TAC) provides to the scientific community an EMS research dataset that, for 2009, included more than 6 million EMS activations. A dataset that goes back two years is readily available to the public on the NEMSIS website; this dataset, which is continually updated, currently includes more than 14 million records. The NEMSIS TAC currently is working with another 24 states that are making efforts to submit EMS data.

For several decades, federal and scientific reports have publicized the fact that little empirical evidence exists to support much of the clinical care that is performed in an out-of-hospital setting. The vision associated with the NEMSIS national database is that, once populated by the majority of states and territories, it would serve as the dataset used by researchers to evaluate the effectiveness and efficiency of patient care provided by EMS agencies, whether they are hospital-based, fire-based, or operating at a community or private level.

Currently, public officials and policymakers are attempting to ensure that pre-hospital-based medical practice is "evidence-based," i.e., healthcare practice based upon the best-available scientific evidence. The NEMSIS project is building a national infrastructure, based upon the clinical information we provide, to document and evaluate the patient care we offer. Our ability to offer beneficial patient care will improve if the data is evidence-based and continually evaluated. Only through the use of a standardized EMS dataset can pre-hospital care be analyzed and improved upon on a national level.

Is NEMSIS Part of NFIRS?

Essentially, the answer is "no." NEMSIS recognizes that fire departments nationwide collect fire-related information. The data related to a true fire incident are significantly different than the data necessary to document a pre-hospital patient-care response and encounter. Collecting data for NFIRS and NEMSIS may appear to be a duplication of efforts by fire personnel, but with systems integration some of the data can be shared. On a fire incident, if patient care is provided, such data can be populated from one system to the other. Those data elements may include details related to the incident address, the patient's age and gender, the EMS provider's assessment and impression of the patient's condition, and the treatment provided — all are pieces of information that can be shared between the two systems.

Generally speaking the NFIRS dataset rarely is expanded between what is collected at the local department level to what is collected at the state and national levels. If approved by the state fire marshal's office, NFIRS data can be submitted directly by a fire department to the national database. The state fire marshal's office can in turn get such data back from the NFIRS for each fire department within its state.

This same functionality does not exist within NEMSIS. The NEMSIS Version 2.2.1 EMS dataset includes more than 400 elements. Of those elements, a small subset is submitted to NEMSIS and the national repository. (See "NEMSIS Version 2.2.1 Dataset Core.") For its own purposes, an EMS agency needs more information, such as the following:

• Patient's name and address.
• Patient's date of birth.
• Detailed information about the incident site.
• Details related to the responding crew members (including names, certification levels, and roles in relation to a particular response, such as driver or primary caregiver).
• The treatments administered by crew members to the patient.
• The success rate for specific treatments.

NEMSIS and Fire-Based EMS Agencies

Although this information may be required or is of interest at the state level, these data currently are not required at the national level. Therefore, the data cannot first be submitted to NEMSIS and later be provided back to the state. Although the NEMSIS TAC is a public health authority as an agent of the National Highway Traffic Safety Administration, NEMSIS does not collect protected health information.

Fire departments were responsible for about 39% of the 1.6 million records submitted to NEMSIS in 2009. As the NEMSIS national database grows, those numbers are expected to increase, largely because of the states that will begin to submit data. (View the states that already have submitted data to NEMSIS.)

But it also will grow as departments strive for greater transparency, which is especially critical for fire departments, which traditionally have not been self-sustaining. Consequently, the need exists for fire administration to report to city councils the work that is being performed by stations and personnel, in order to justify the department's budget.

More and more fire departments, if they are not providing EMS care and transport currently, are moving in that direction. Through the use of the NEMSIS standard, an electronic EMS data collection system, good EMS documentation by fire personnel — aided by proper education and quality-assurance processes — and good reporting tools, fire departments can provide the requisite transparency to their city councils.

There are ways the ePCR data can be utilized by fire department personnel to make decisions. The initial step is to ensure that all of the data is being documented accurately by personnel. A quality-assurance process should start immediately. Identify what data is lacking and who needs to improve their documentation skills. Fire department and EMS agencies can use the NEMSIS version 2.2.1 data, utilizing their own EMS ePCR software program.

Once the data is in the system, users can mine many different types of information that will increase and improve the functionality of the department. Frequent NEMSIS dataset queries used by EMS agencies nationally for quality-assurance purposes include the following:

• Response times (by vehicle, crew member, day of week, time of day, and adherence to an agency or local standard).
• Incident disposition by crew member (no loads).
• Patient treatments (medications administered and procedures performed).
• Transport of patients to appropriate destinations.
• Hospital team activations based on agency protocol.
• Incident dispositions based on provider primary impression (PPI), for example, diabetic. This data can be queried at an agency/department level based on the individual crew member, shift or station, or on the agency/department as a whole.

The use of a qualified EMS software product that adheres to the NEMSIS dataset, coupled with good, accurate, valid ePCR documentation only can increase the amount of useful information available to department personnel. Whether that person is a firefighter, EMT-basic, EMT-paramedic, captain, or fire chief does not matter: ePCR data enhances knowledge — and, as the 16th-century philosopher Sir Francis Bacon once opined, knowledge is power. It's all in how you use the data.

Karen Jacobson, BA, NREMT-P, is the director of NEMSIS. She also is with the University of Utah School of Medicine's Department of Pediatrics, Critical Care. For more information, contact the NEMSIS Technical Assistance Center at www.nemsis.org.

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