Data Elements
The tables below list data elements available in NC DETECT line listing reports for each data source.
- Emergency Department Data (ED)
- EMS Data Elements Received from 2018 – Present: NEMSIS V.3 (EMS Data Source in NC DETECT)
- EMS Data Elements Received from 2009 – 2018: NEMSIS V.2 (PreMIS Data Source in NC DETECT)
- North Carolina Poison Control Data Elements (CPC Data Source in NC DETECT)
Emergency Department Data
Inclusion Criteria: Patients treated in the participant ED regardless of their disposition and patients triaged who then leave AMA or without being seen. Also patients treated in the ED and then admitted to the hospital are included. Exclusion Criteria: Patients triaged away to a clinic or directly admitted to an inpatient unit.
| Name | Description/Notes |
|---|---|
| Patient Age | Available in years |
| Sex | M (Male), F (Female), U (Unknown) |
| Patient City | Patient’s city of residence |
| Patient County | Patient’s county of residence |
| Patient ZIP | Patient's ZIP of residence (5-digit) |
| Patient State | Patient’s state of residence |
| Visit ID | NC DETECT-generated identifier that uniquely identifies that ED visit |
| Hospital | Emergency department facility where patient sought care |
| Insurance Coverage (or Other Expected Source of Payment) | Entity or person expected to be responsible for patient’s bill for this ED visit (private insurance, self-pay, Medicare, Medicaid, etc.) |
| Arrival Date and Time | First date and time documented in patient’s record for this ED visit |
| Transport Mode | Patient’s mode of transport to ED (walk-in, ground ambulance, etc.) |
| Chief Complaint | Patient’s reason for seeking care or attention, expressed in terms as close as possible to those used by patient or responsible informant |
| Triage Notes | Supporting information for Chief Complaint documented by the triage nurse |
| Blood Pressure | Initial blood pressure taken at triage |
| Initial Temperature | Initial temperature taken at triage (in Celsius) |
| Disposition | Patient’s anticipated location or status following ED visit (discharged, admitted, transferred, died, etc.) |
| Disposition Diagnosis Description | Practitioner’s description of condition or problem for which services were provided during patient’s ED visit, recorded at time of disposition |
| ICD-9-CM Code(s) ICD-10-CM Code(s) | ICD-9-CM Final Diagnosis or Injury Codes (2009 - September 30, 2015) ICD-10-CM Final Diagnosis or Injury Codes (October 1, 2015 - Present) |
| Patient Race | American Indian, Asian, Black or African American, Pacific Islander, Other |
| Patient Ethnicity | Hispanic Origin; Not of Hispanic Origin |
EMS Data Elements Received 2018 – Present: NEMSIS V.3
(EMS Data Source in NC DETECT)
Most EMS agencies are now documenting EMS encounters using the NEMSIS V.3 data standard and transmitting these data to the NC state data repository now managed by ESO. NC DETECT receives a subset of these data daily and the data elements available in the NC DETECT line listing reports are shown below.
| Data Element | Description |
|---|---|
| Agency Name | EMS Agency name |
| Chief Complaint | Free-text narrative of the patient's chief complaint |
| Destination | Destination of patient transport (if transported) |
| Dispatch Complaint | Complaint reported at dispatch (pick list) |
| Disposition | Disposition after EMS encounter (Patient treated, transported by this EMS Unit; Patient Evaluated, No Treatment/Transport Required, etc.) |
| EMS County | County location of EMS Agency |
| EMS ID | Unique identifier for the EMS encounter |
| Incident City | City of incident location |
| Incident Location Type | Standardized field based on ICD-10-CM place of occurrence codes (residence, nursing home, trade and service area, etc.) |
| Incident Zip | ZIP of incident location |
| Mass Casualty | Yes, No, Not Recorded, Not Applicable |
| Meds Administered | Medications administered by the EMS agency |
| Narrative | Free-text narrative of the EMS encounter |
| Patient Age | Patient's age |
| Patient Destination Date and Time | Date and time patient arrived at destination (if applicable) |
| Patient Gender | Patient's gender |
| Patient Zip | Patient's ZIP of residence |
| Patients At Scene | Number of patients at scene |
| Primary Impression | ICD-10-CM Coded Diagnosis |
| Race | Patient's Race |
| Second Complaint | Free-text narrative of the patient's secondary complaint (if applicable) |
| Secondary Impression | ICD-10-CM Coded Diagnosis |
| Symptoms | ICD-10-CM Coded Diagnosis |
| Unit Notification Date Time | Date and time unit notified by dispatch |
EMS Data Elements Received from 2009 – 2018: NEMSIS V.2
(PreMIS Data Source in NC DETECT)
| Data Element | Description / Notes |
|---|---|
| Agency county | EMS Agency county |
| Agency name | EMS Agency name |
| Anatomic location | Pick list: Abdomen, Back, Chest, Extremity-Lower, Extremity-Upper, General/Global, Genitalia, Head, Neck |
| Chief complaint | Free-text narrative of the patient's chief complaint, as close as possible |
| Destination Name | |
| Destination Type | |
| Dispatch complaint | Abdominal Pain, Allergic Reaction, Animal Bites, Assault, Back Pain, Breathing Problems, Burns, Carbon Monoxide/Inhalation, Cardiac/Respiratory Arrest, Chest Pain, Choking, Convulsions/Seizure, Diabetic Problem, DOA, Drowning, Electrocution, Eye Problem, FALLS/Back Injury, FIRE, HAZARDOUS MATERIAL, Headache, Heart Problems, Heat/Cold Exposure, Hemorrhage/Laceration, Industrial/Machinery Accidents, Ingestion/Poisoning, LIFE LINE, OVERDOSE/POISONING, Pregnancy/Childbirth, PSYCHIATRIC/SUICIDE, SEIZURES, Sick Person, Stab/Gunshot Wound, STANDBY/SPECIAL EVENT, STROKE, SUBSTANCE ABUSE, Traffic Accident, TRANSPORT, Traumatic Injuries, Unconscious, Unknown Problem/Man Down, Transfer/Interfacility/Palliative Care, MCI |
| Incident address | |
| Incident city | |
| Incident Disposition | Treated, Refused, Dead. EMS calls with an incident disposition of Cancelled, No Treatment Required, or No Patient Found are not sent to NC DETECT. |
| Incident Facility Code | |
| Incident Location Type | |
| Incident state | |
| Incident zip code | |
| Mass casualty | Yes/No |
| Medications Administered | free text |
| Patient address city | |
| Patient address state | |
| Patient address zip code | |
| Patient age | |
| Patient age unit (Years, Months, Days, Hours) | |
| Patient birth date | |
| Patient Destination date and time | |
| Patient gender | |
| Patients at scene | single or multiple |
| Primary symptom name | Pick list: Bleeding, Breathing Problems, Change in Responsiveness, Choking, Death, Device/Equipment Problem, Diarrhea, Drainage/Discharge, Fever, HEADACHE, Malaise, Mass/Lesion, Mental/Psych, MENTAL STATUS CHANGE, Nausea/Vomiting, NONE DETECTED, Pain, Palpitations, Rash/Itching, Swelling, Transport Only, Weakness, Wound |
| Provider Primary Impression | |
| Provider Secondary Impression | |
| Secondary complaint | Free-text narrative of the patient's secondary complaint(s), as close as possible a quote from the patient |
| Secondary symptom name | See Primary Symptom Name |
| Unit notified timestamp | |
| Vital Signs: Blood pressure, Temperature, pulse oximetry, respiratory rate | |
| Work related | Yes / No / Not Recorded |
North Carolina Poison Control (NCPC) Data Elements
North Carolina Poison Control (NCPC) is the designated Statewide Poison Control Center for North Carolina and certified as a Regional Poison Control Center by the American Association of Poison Control Centers. NCPC is an emergency telephone resource of poisoning information, staffed 24 hours a day, seven days a week, by registered nurses and pharmacists (specialists in poison information) who are specially trained to provide diagnostic and treatment advice for acute and chronic poisonings to the public and healthcare professionals.
More information is available at www.ncpoisoncontrol.org
| Data Element | Description |
|---|---|
| Call Date and Time | Date and time of call to CPC |
| Call Type | Call type listed as exposure, information or drug identification |
| Call Type Category | Subcategories for information call types |
| Caller City | City where call was made |
| Caller County | County where call was made |
| Caller Location Code | Zip code or area code/exchange of caller |
| Caller Site | Location of caller at initial call (residence, workplace, etc.) |
| Caller State | State where initial call was made |
| Caller Zip | Zip code where call was made |
| Case Number | Unique number for patient |
| Chronicity | Records exposure as acute or chronic |
| Clinical Effects | 9 categories of clinical effects (cardiovascular, dermal, gastrointestinal, hematologic/hepatic, neurological, ocular, renal/genitourinary, respiratory, and miscellaneous). Each clinical effect is recorded as no effect, related, not related, or unknown if related |
| Duration of Effect | Duration of clinical effects |
| Exposure Duration | Duration of chronic exposures |
| Exposure Reason | Type of exposure if call type was an exposure call |
| Exposure Site | Location of the patient when the exposure occurred |
| Final Health Care Facility | Type of health care facility for patients transferred from the initial HCF to a second HCF |
| Follow up Number | Number of follow-up contacts for each patient |
| Initial Health Care Facility | Type of health care facility patient is in or referred to |
| Medical Outcome | Final outcome of patient after final follow-up |
| Multiple Patients? | Yes/No |
| Patient Age | |
| Patient Age Group | |
| Patient Gender | |
| Patient Pregnancy Duration | Number of weeks pregnant |
| Product ID | Identifier for product involved in call |
| Related Case Number | Case number of primary case/call related to patient |
| Route | Exposure Route: Aspiration, Bite, Dermal, Ingestion, Inhalation, Ocular, Other, Otic, Parenteral, Rectal, Unknown, Vaginal |
| Scenarios | 7 categories of possible exposure scenarios (dosing/therapeutic error, vapor/fume problems, child-resistant closure on product, access to product, confusion about product, pesticide problems, miscellaneous). Up to four scenarios can be selected per case |
| Substances | Information on all substances involved in exposure |
| Therapies | 2 categories of therapy provided (decontamination or other). Each therapy is recorded as not recommended, recommended, performed, recommended and performed, or recommended, known not performed. |