Rptfieldsnew

Required /
Field Name
Definition
Optional
CauseOfInjury
E844.0 Aircraft related accidentE858.8 Accidental chemical poisoningE888.0 Accidental fallE821.0 ATV Rider (Unitentional)E967.0 Battering/maltreatment (Assaultive)E905.0 Bites and stings (Unitentional)E918.0 Caught in/between objects (Unitentional)E920.0 Cut/stab (unintentional)E956.0 Cut/stab (Self-inflicted)E966.0 Cut/stab (Assaultive)E986.0 Cut/stab (Undetermined)E830.0 Drowning/submersion (Unintenional)E954.0 Drowning/submersion (Self-inflicted)E964.0 Drowning/submersion (Assaultive)E984.0 Drowning/submersion (Undetermined)E925x Electrocution (non-lightning)E880.0 Fall (Unintentional)E957.0 Fall (Self-inflicted)E968.1 Fall (Assaultive)E987.0 Fall (Undetermined)E890.0 Fire/Flame (unintentional)E958.1 Fire/Flame (Self-inflicted)E968.0 Fire/Flame (Assaultive)E988.1 Fire/Flame (undetermined)E922.0 Firearm (unintentional)E955.0 Firearm (Self-inflicted)E965.0 Firearm (Assaultive)E985.0 Firearm (undetermined)E914.0 Foreign body entering eye/orifice (Unitentional)E924.0 Hot object/substance (Unintentional)E958.2 Hot object/substance (Self-inflicted)E988.2 Hot object/substance (Assaultive)E907x LightningE919.0 Machinery (Unitentional)E810.0 MV traffic, occupant (Unitentional)E810.0 MV traffic, motorcyclist (Unitentional)E810.0 MV traffic, pedal cyclist (Unitentional)E810.0 MV traffic, pedestrian (Unitentional)E810.0 MV traffic, other/unspecified (Unitentional)E985.5 MV traffic, other/unspecified (Self-inflicted)E968.5 MV traffic, other/unspecified (Assaultive)E988.5 MV traffic, other/unspecified (Undetermined)E900.0 Natural/environmental (Unitentional)E958.3 Natural/environmental (Self-inflicted)E988.3 Natural/environmental (UndeterminedE921.0 Other injury (Unitentional)E955.0 Other injury (Self-inflicted)E965.0 Other injury (Assaultive)E985.0 Other injury (UndeterminedE927.0 Overexertion (Unitentional)E800.0 Pedal cyclist, other (unitentional)E800.0 Pedestrian, other (unitentional)E850.0 Poisoning (Unitentional)E950.0 Poisoning (Self-inflicted)E962.0 Poisoning (Assaultive)E980.0 Poisoning (Undetermined)E926x Radiation exposureE960.1 Rape (Assaultive)E820.0 Snowmobile rider (Unitentional) Required /
Field Name
Definition
Optional
E800.0 Transport, other (Unitentional)E958.6 Transport, other (Unitentional)E988.6 Transport, other (Undetermined)E89x2 Smoke inhalationE916.0 Struck by or against (Unitentional)E960.0 Struck by or against (Assaultive)E911.0 Suffocation (Unitentional)E953.0 Suffocation (Self-inflicted)E963.0 Suffocation (Assaultive)E983.0 Suffocation (Undetermined)E887.0 Unspecified (Unitentional)E958.9 Unspecified (Self-inflicted)E968.9 Unspecified (Assaultive)E988.9 Unspecified (Undetermined)E83xx Water transport accidentE0007 Not reportedE0008 Not applicableE0009 Unknown 68/26-28
Personnel certification # issued 6 digit EMSRB issued certificationby EMSRB 111111 Physican222222 Registered Nurse333333 First Responder444444 Other Health Care Professional777777 Not reported888888 NA999999 Unknown 128/none
01 EMT-Basic02 EMT-Intermediate03 EMT-Paramedic04 Physician05 RN06 First Responder07 Other health care professional77 Not Reported88 Not Applicable99 Unknown 127/none
03 Pilot04 Fire Company05 First Responder06 Ride Along77 Not Reported88 Not Applicable99 Unknown FactorsAffectingCare
special circumstances affecting 01 Adverse weatherthe EMS response or delivery 03 Vehicle problems04 Unsafe scene05 Language barrier06 Prolonged extrication (>20 min)07 Hazardous material08 Crowd Control09 MCI10 Technical rescue11 Not reported09 Other77 Not reported88 Not applicable99 Unknown FirstResponder
Required /
Field Name
Definition
Optional
128/none
The range of the score is 3 to 15 two numeric 01 Pain w/o swelling/bruising02 Soft tissue swelling/bruising03 Blunt injury04 Laceration05 Dislocation/fracture06 Puncture/stab07 Gunshot08 Amputation09 Crush10 Burn77 Not Reported88 Not applicable99 Unknown 128/None InjurySite
B Head only (excluding neck, cervical spine and ear)C Face (including ear)D NeckE Thorax (excluding thoracic spine)F Abdomen (excluding lumbar spine)G SpineH Upper extremitiesI Lower extremities or bony pelvisJ Body region unspecified Medication
121/none
01 MG02 ML03 mcq04 meq05 Grams06 Units07 Lpm08 cc/hr09 mcq/min10 gtt/min11 mg/min12 units/hr77 Not Reported88 Not Applicable99 Unknown 405 Abciximab (Reopro)061 Adenosine031 Albuterol065 Amiodarone004 Amyl nitrate081 Aspirin021 Atropine Required /
Field Name
Definition
Optional
060 Atrovent062 Bretylium008 Bumetanide161 Calcium chloride010 Calcium gluconate111 Charcoal, activated012 Dexamethasone171 Dextrose 50% (D50)121 Diazepam (Valium)011 Diphenhydramine (Benadryl)300 Dobutamine016 Dopamine142 Droperidol (Inapsine)034 Epinephrine418 Epi-Pen Adult419 Epi-Pen Junior407 Eptifibatide (Integrilin) 141 Etomidate325 Fentanyl413 Flumazenil (Romazicon)132 Furosemide (Lasix)231 Glucagon408 Glutose414 Haloperidol (Haldol)051 Heparin409 Hydromorphone (Dilaudid)412 Insulin201 Ipecac022 Ipratropium Bromide067 Isoproterenol417 IV Antibiotics163 Labetolol063 Lidocaine024 Lorazepam131 Magnesium sulfate182 Mannitol (Osmitrol)416 Mark 1 Kit027 Meperidine (Demerol)028 Metaproterenol (Alupent)222 Methylprednisolone (Solu-Medrol)030 Metoclopramide350 Metoprolol (Lopressor)122 Midazolam (Versed)092 Morphine101 Naloxone042 Neostigmine033 Nifedipine (Adalat, Procardia)072 Nitroglycerin143 Nitronox068 Nitroprusside404 Normal Saline888 Not Applicable777 Not Reported093 Nubain411 Oxytocin (Pitocin)064 Procainamide415 Prochlorperazine (Compazine)403 Promethazine HCl (Phenergan)521 Proparacaine (Alcaine)402 Racemic Epinephrine 172 Reactose410 Rocuronium Bromide (Zemuron)151 Sodium bicarbonate041 Succinylcholine (Anectine)032 Terbutaline (Brethine)039 Thiamine406 Tirofiban HCL (Agrastat)038 Toradol (Ketorolac)999 Unknown401 Vasopressin400 Vecuronium (Norcuron) Required /
Field Name
Definition
Optional
066 Verapamil (Isoptin)425 Zofran (Ondansetron) 02 IM 03 SQ 04 SL05 oral06 rectal 07 inhalation08 IO 09 ET 77 Not Reported88 Not Applicable99 Unknown PreExistingCond
41200 Cardiac25000 Diabetes01190 Tuberculosis49280 Emphysema51881 Chronic respiratory58500 Chronic Renal Failure23990 Cancer40190 Hypertension31290 Psychiatric problems78030 Seizure disorder failureV4400 Tracheostomy79990 Other77777 Not Reported88888 Not Applicable99999 Unknown Procedure
02 condition worsened 03 no change 77 Not Reported88 Not Applicable99 Unknown 6 digit Certification Number issued by the EMSRB777777 Not Reported888888 Not Applicable999999 Unknown 9356 Application - pressure dressing12381 Application - wound dressing9670 Assisted ventilation (positive pressure)9359 Backboard3998 Bleeding Controlled9408 Blood Draw9409 Blood glucose9357 Burn care9960 Cardiopulmonary Resuscitation9964 Cardioversion Required /
Field Name
Definition
Optional
12349 Central Line Placement9352 Cervical immobilization12348 Chest Tube Placement12372 Cold Pack9603 Combitube12351 C-PAP3110 Cricothyrotomy12354 Defibrillator Application9820 Direct laryngscope8951 ECG monitoring9604 Endotracheal intubation8938 End-tidal CO2 monitoring12383 ETTL (Posi-Tube,Tube Check-B)9963 External cardiac massage9962 External defibrillation (includes auto)12350 External Jugular IV3964 External pacing12373 Extrication12374 Hot Pack9910 I.M./Sub Q medications4192 Intraosseous catheter3893 Intravenous catheter9929 Intravenous fluids12375 Irrigation9984 Isolation procedures9920 IV medications12344 KED12352 LMA9358 MAST (military antishock trousers)9394 Medication by nebulization9605 Nasogastric tube insertion9601 Nasopharyngeal airway insertion3332 Needle thoracostomy8888 Not Applicable7777 Not Reported7359 Obstetrical care (delivery)12342 Oral Medications9602 Oropharyngeal airway insertion7999 Other12360 Oxygen by Blow By9397 Oxygen by mask9396 Oxygen by nasal canula12347 Pericardiocentesis12385 Portable Ventilator8967 Pulse Oximetry12345 Short Board1234 Soft Stretcher/Scoop Stretcher9355 Splint of Extremity12376 Stair Chair12377 Stretcher12343 Sublingual Medications1235 Suction9354 Traction Splint12382 Transtracheal Ventilation12378 Trendellenburg position9999 Unknown12379 Vagal Manuever12384 Visualize Cords12341 Vital signs was the procedure successfully 01 yes completed 02 no77 Not Reported88 Not Applicable99 Unknown amb service license # assigned 4 digit Ambulance License Numberby EMSRB that has been requested to respond to request Required /
Field Name
Definition
Optional
02 Drugs, yes03 Alcohol/Drugs, yes04 No77 Not reported88 Not applicable99 Unknown 126/none
01 Patient is alert and oriented X302 Responds to voice03 Responds to pain04 Patient is unresponsive77 Not reported88 Not applicable99 Unknown 02 EMS Responder77 Not reported88 Not Applicable99 Unknown 02 Patient/Family Choice03 Patient Physician Choice04 Managed Care05 Law Enforcement Choice06 Protocol07 Specialty Resource Center08 On-line Medical Direction09 Diversion10 Other11 MCI Protocol12 Weather, system, supervisor77 Not reported88 Not Applicable99 Unknown 101/none
01 Home02 Police/jail03 Medical Office/clinic04 Other EMS responder (ground)05 Other EMS responder (air)06 Hospital07 Morgue08 Other09 Detox77 Not reported88 Not applicable99 Unknown 39/other
01 Abdominal Pain/Problems02 Allergies (reactions) / Envenomations (stings,bites)03 Animal Bite / Attacks04 Assualt / Sexual Assault05 Back Pain (Non - Traumatic or Non Recent Trauma)06 Breathing Problems07 Burns (Scalds) / Explosion08 Carbon Monoxide / Inhalation / Hazmat09 Cardiac or Respiratory Arrest / Dealth Required /
Field Name
Definition
Optional
10 Chest Pain11 Choking12 Convulsions13 Diabetic Problems14 Drowing (Near) / Diving / Scuba Accident15 Electrocution / Lighting16 Eye Problems / Injuries17 Falls18 Headache19 Heart Problems / A.I.C.D.
20 Heat / Cold Exposure21 Hemmorrage / Lacerations22 Industrial / Machinary Accidents23 Overdose / Poisoning (ingestion)24 Pregnancy / Childbirth / Miscarriage25 Psychiatric / Abnormal Behavior / Suicide Attempt26 Sick Person (Specific Diagnosis)27 Stab / Gunshot / Penetrating Trauma28 Stroke (CVA)29 Traffic / Transportation Accidents30 Traumatic Injuries31 Unconscious / Fainting32 Unknown Problem (man down)33 Transfer / Interfacility / Palliative Care34 Standby35 Medical Alarm36 Intercept77 Not reported88 Not applicable99 Unknown 111/none
02 Allergies (reactions) / Envenomations (stings,bites)03 Animal Bite / Attacks04 Assualt / Sexual Assault05 Back Pain (Non - Traumatic or Non Recent Trauma)06 Breathing Problems07 Burns (Scalds) / Explosion08 Carbon Monoxide / Inhalation / Hazmat09 Cardiac or Respiratory Arrest / Dealth10 Chest Pain11 Choking12 Convulsions13 Diabetic Problems14 Drowing (Near) / Diving / Scuba Accident15 Electrocution / Lighting16 Eye Problems / Injuries17 Falls18 Headache19 Heart Problems / A.I.C.D.
20 Heat / Cold Exposure21 Hemmorrage / Lacerations22 Industrial / Machinary Accidents23 Overdose / Poisoning (ingestion)24 Pregnancy / Childbirth / Miscarriage25 Psychiatric / Abnormal Behavior / Suicide Attempt26 Sick Person (Specific Diagnosis)27 Stab / Gunshot / Penetrating Trauma28 Stroke (CVA)29 Traffic / Transportation Accidents30 Traumatic Injuries31 Unconscious / Fainting32 Unknown Problem (man down)33 Transfer / Interfacility / Palliative Care34 Standby Required /
Field Name
Definition
Optional
35 Medical Alarm36 Intercept77 Not reported88 Not applicable99 Unknown address (or best approx) where Free Text 50 alphanumeric characterspt was found, or, if no pt, address to which unit responded found or to which unit responded (or best approx) county where patient was found FIPS codeor to which unit responded (or best approx) 120/none
zip code where pt was found or postal code nnnnnto which unit responded 01 Sinus rhythm 02 Other rhythm from 60-100 (not otherwise listed) 03 Paced rhythm04 Bradycardia 05 Narrow comples tachycardia 06 Wide complex tachycardia 07 Ventricular fibrillation 08 Asystole09 Pulseless electrical activity 88 Not applicable 99 Unknown 02 Self-inflicted03 Assaultive04 Undetermined77 Not reported88 Not applicable99 Unknown 02 Initial emergent, downgraded to no lights or sirens03 Initial non-emergent, upgraded to lights or sirens04 Emergent, with lights or sirens77 Not reported88 Not applicable99 Unknown 02 Initial emergent, downgraded to no lights or sirens03 Initial non-emergent, upgraded to lights or sirens04 Emergent, with lights or sirens77 Not reported88 Not applicable99 Unknown Required /
Field Name
Definition
Optional
8491 Farm8492 Mine or quarry8493 Industrial place and premises8494 Place for recreation or sport8495 Street or highway8496 Public Building8497 Residential Institution/Hospital/Nursinh Home849E Educational Institution8498 Other specified location8499 Unspecified location849C Health clinic849U Unknown 03 On-Scene04 Written Orders (Patient Specific)77 Not Reported88 Not Applicable99 Unknown {3 digits for age in years}777 Not Reported888 Not Applicable999 Unknown000 For patients up to 1 year of age 01 male02 female77 Not Reported99 unknown/unspecified 9 digit ssn777777777 Not Reported888888888 Not Applicable999999999 Unknown 122/none
02 EMS responder77 Not Reported88 Not Applicable99 Unknown 99530 Allergic reaction78009 Altered level of consciousness49390 Asthma Required /
Field Name
Definition
Optional
31290 Behavioral/psychiatric disorder42750 Cardiac arrest42751 Cardiac arrest suspect (near) drowning42753 Cardiac arrest suspect other79911 Cardiac arrest suspect primary respiratory42754 Cardiac arrest suspect SIDS42755 Cardiac arrest suspect trauma42790 Cardiac rhythm disturbance78650 Chest pain/discomfort25090 Diabetic symptoms (hypoglycemia)99480 Electrocution57890 GI Bleed40190 Hypertension78060 Hyperthermia45890 Hypotension78090 Hypothermia78559 Hypovolemia/shock98790 Inhalation Injury (smoke/toxic gas)00088 Not Applicable00077 Not Reported79899 Obvious death79990 Other56990 Other GI symptoms97790 Poisoning/drug ingestion65990 Pregnancy/OB delivery79910 Respiratory arrest78609 Respiratory distress78030 Seizure95991 Sexual Assult/Rape98950 Stings/venomous bites43600 Stroke/CVA78020 Syncope/fainting98990 Toxic exposure95990 Traumatic Injury62380 Vaginal hemorrhage00099 Unknown received by a PSAP or other designated entity 124/none
02 No03 Shock not indicated04 Device not applied (or not working)05 Yes, but re-arrest prior to ambulance06 No device available77 Not Reported88 Not Applicable99 Unknown 02 Other ambulance service03 91104 Healthcare facility05 Medical Alarm06 Other77 Not Reported88 Not Applicable99 Unknown response assignment (e.g. cancelled, clear hospital, leave pt, etc.) 01 Treated, transported by EMS02 Treated, transferred care03 Treated, transported by private vehicle04 Treated and released05 No treatment required06 Patient refused care Required /
Field Name
Definition
Optional
07 Dead at scene08 Cancelled77 Not Reported88 Not Applicable99 Unknown 00 No patient found 125/none
02 No03 ROSC >5 minutes77 Not Reported88 Not applicable99 Unknown provided) by the responding unit 02 Specialized Life Support-Basic 03 Advanced Life Support04 Specialized Life Support-Advanced05 Basic Life Support-Air06 Specialized Life Support-Advanced Air07 Part-Time Advanced Life Support77 Not Reported88 Not Applicable99 Unknown 01 Scene Response02 Unscheduled Interfacility Transfer 03 Scheduled Interfacility Transfer04 Standby05 Intercept06 Mutuial aid77 Not Reported88 Not Applicable99 Unknown 106/none
{3 digits for miles}777 Not reported888 Not Applicable999 Unknown000 For distances less than 1 mile {3 digits for miles}777 Not reported888 Not Applicable999 Unknown000 For distances less than 1 mile 03 call not in PSA04 other77 Not Reported88 Not Applicable99 unknown/not reported 123/none
02 First Responder with AED03 Emergency Response Unit with AED04 No pre-ambulance AED77 Not reported88 Not applicable99 Unknown Required /
Field Name
Definition
Optional
03 Critical care ground04 ERU05 Rotor craft06 Fixed wing07 Other08 None77 Not Reported88 Not Applicable99 Unknown SafetyEquipment
02 Shoulder belt only03 Lap belt only04 Shoulder and lap belt05 Child safety seat06 Airbag deployed, no lap belt07 Airbag deployed, lap belt used08 Airbag deployed, shoulder belt used09 Airbag deployed, lap and shoulder used10 Airbag deployed, child safety seat used11 Helmet12 Eye protection13 Protective clothing14 Personal flotation device15 Protective clothing/gear77 Not Reported88 Not Applicable99 Unknown Symptoms
72450 Back pain57810 Bloody stools78609 Breathing difficulty42750 Cardioresp arrest78650 Chest pain93310 Choking55890 Diarrhea78040 Dizziness38870 Ear pain37991 Eye pain78060 Fever/Hyperthermia78400 Headache40190 Hypertension78090 Hypothermia78700 Nausea78510 Palpitations34490 Paralysis78510 Palpitations65990 Pregnancy/childbirth/miscarriage78030 Seizures/convulsions78020 Syncope78009 Unresponsive/unconscious62380 Vaginal bleeding78700 Vomiting78070 Weakness (malaise)79990 Other00088 No signs and symptoms00099 Not reported Required /
Field Name
Definition
Optional
Patient's systolic blood pressure {3 digits} 777 Not reported888 Not Obtained999 Unknown

Source: http://www.emsrb.state.mn.us/docs/EMSRB_Data_Dictionary_Version_2-11.pdf