Section 836 IAC 1-1-5 - Reports and recordsAuthority: IC 16-31-2-7; IC 16-31-3
Affected: IC 4-21.5; IC 16-31-3
Sec. 5.
(a) All emergency medical service provider organizations shall participate in the emergency medical service system review by collecting and reporting data elements for all emergency medical service provider organization runs. The elements shall be submitted to the agency by 11:59 p.m. of the day following the completion of the run by electronic format in the manner specified by the commission. The data elements prescribed by the commission are the following National Emergency Medical Service Information System (NEMSIS) Version 3 data elements:(1) Emergency medical services (EMS) agency unique state identification (ID) (dAgency.01).(2) EMS agency number (dAgency.02).(3) EMS agency name (dAgency.03).(4) EMS agency state (dAgency.04).(5) EMS agency service area states (dAgency.05).(6) EMS agency service area counties (dAgency.06).(7) EMS agency census tracts (dAgency.07).(8) EMS agency service area ZIP codes (dAgency.08).(9) Primary type of service (dAgency.09).(10) Other types of service (dAgency.10).(11) Level of service (dAgency.11).(12) Organization status (dAgency.12).(13) Organizational type (dAgency.13).(14) EMS agency organizational tax status (dAgency.14).(15) Statistical calendar year (dAgency.15).(16) Total primary service area size (dAgency.16).(17) Total service area population (dAgency.17).(18) 911 EMS call center volume per year (dAgency.18).(19) EMS dispatch volume per year (dAgency.19).(20) EMS patient transport volume per year (dAgency.20).(21) EMS patient contact volume per year (dAgency.21).(22) National provider identifier (dAgency.25).(23) Fire department ID number (dAgency.26).(24) State associated with the certification/licensure levels (dConfiguration.01).(25) State certification/licensure levels (dConfiguration.02).(26) Procedures permitted by the state (dConfiguration.03).(27) Medications permitted by the state (dConfiguration.04).(28) Protocols permitted by the state (dConfiguration.05).(29) EMS certification levels permitted to perform each procedure (dConfiguration.06).(30) EMS agency procedures (dConfiguration.07).(31) EMS certification levels permitted to administer each medication (dConfiguration.08).(32) EMS agency medications (dConfiguration.09).(33) EMS agency protocols (dConfiguration.10).(34) EMS agency specialty service capability (dConfiguration.11).(35) Emergency medical dispatch (EMD) provided to EMS agency service area (dConfiguration.13).(36) Patient monitoring capabilities (dConfiguration.15).(37) Crew call sign (dConfiguration.16).(38) EMS personnel's state's licensure ID number (dPersonnel.23).(39) EMS personnel's state EMS certification licensure level (dPersonnel.24).(40) Indications for invasive airway (eAirway.01).(41) Date and time airway device placement confirmation (eAirway.02).(42) Airway device being confirmed (eAirway.03).(43) Airway device placement confirmed method (eAirway.04).(44) Type of individual confirming airway device placement (eAirway.06).(45) Crew member ID (eAirway.07).(46) Airway complications encountered (eAirway.08).(47) Suspected reasons for failed airway procedure (eAirway.09).(48) Cardiac arrest (eArrest.01).(49) Cardiac arrest etiology (eArrest.02).(50) Resuscitation attempted by EMS (eArrest.03).(51) Arrest witnessed by (eArrest.04).(52) Cardiopulmonary resuscitation (CPR) care provided prior to EMS arrival (eArrest.05).(53) Who provided CPR prior to EMS arrival (eArrest.06).(54) Automated external defibrillator (AED) use prior to EMS arrival (eArrest.07).(55) Who used AED prior to EMS arrival (eArrest.08).(56) Type of CPR provided (eArrest.09).(57) First monitored arrest rhythm of the patient (eArrest.11).(58) Any return of spontaneous circulation (eArrest.12).(59) Date/time of cardiac arrest (eArrest.14).(60) Date/time resuscitation discontinued (eArrest.15).(61) Reason CPR/resuscitation discontinued (eArrest.16).(62) Cardiac rhythm on arrival at destination (eArrest.17).(63) End of EMS cardiac arrest event (eArrest.18).(64) Crew member ID (eCrew.01).(65) Crew member level (eCrew.02).(66) Crew member response role (eCrew.03).(67) Complaint reported by dispatch (eDispatch.01).(68) EMD performed (eDispatch.02).(69) Destination transferred to, name (eDisposition.01).(70) Destination transferred to, code (eDisposition.02).(71) Destination state (eDisposition.05).(72) Destination county (eDisposition.06).(73) Destination ZIP code (eDisposition.07).(74) Number of patients transported in this EMS unit (eDisposition.11).(75) Incident/patient disposition (eDisposition.12).(76) EMS transport method (eDisposition.16).(77) Transport mode from scene (eDisposition.17).(78) Additional transport mode descriptors (eDisposition.18).(79) Final patient acuity (eDisposition.19).(80) Reason for choosing destination (eDisposition.20).(81) Type of destination (eDisposition.21).(82) Hospital inpatient destination (eDisposition.22).(83) Hospital capability (eDisposition.23).(84) Destination team prearrival alert or activation (eDisposition.24).(85) Date/time of destination prearrival alert or activation (eDisposition.25).(86) Estimated body weight in kilograms (eExam.01).(87) Barriers to patient care (eHistory.01).(88) Advance directives (eHistory.05).(89) Medication allergies (eHistory.06).(90) Alcohol/drug use indicators (eHistory.17).(91) Cause of injury (eInjury.01).(92) Mechanism of injury (eInjury.02).(93) Trauma center criteria (eInjury.03).(94) Vehicular, pedestrian, or other injury risk factor (eInjury.04).(95) Main area of the vehicle impacted by the collision (eInjury.05).(96) Location of patient in vehicle (eInjury.06).(97) Use of occupant safety equipment (eInjury.07).(98) Airbag deployment (eInjury.08).(99) Height of fall (feet) (eInjury.09).(100) Date/time medication administered (eMedications.01).(101) Medication administered prior to this unit's EMS care (eMedications.02).(102) Medication given (eMedications.03).(103) Medication administered route (eMedications.04).(104) Medication dosage (eMedications.05).(105) Medication dosage units (eMedications.06).(106) Response to medication (eMedications.07).(107) Medication complication (eMedications.08).(108) Medication crew (healthcare professionals) ID (eMedications.09).(109) Role/type of person administering medication (eMedications.10).(110) Patient care report narrative (eNarrative.01).(111) Personal protective equipment used (eOther.03).(112) Suspected EMS work related exposure, injury, or death (eOther.05).(113) Crew member completing this report (eOther.08).(114) Emergency department disposition (eOutcome.01).(115) Hospital disposition (eOutcome.02).(116) Last name (ePatient.02).(117) First name (ePatient.03).(118) Middle initial/name (ePatient.04).(119) Patient's home address (ePatient.05).(120) Patient's home city (ePatient.06).(121) Patient's home county (ePatient.07).(122) Patient's home state (ePatient.08).(123) Patient's home ZIP code (ePatient.09).(124) Gender (ePatient.13).(125) Race (ePatient.14).(127) Age units (ePatient.16).(128) Date of birth (ePatient.17).(129) Primary method of payment (ePayment.01).(130) Closest relative/guardian last name (ePayment.23).(131) Closest relative/guardian first name (ePayment.24).(132) Centers for Medicare and Medicaid Services (CMS) service level (ePayment.50).(133) Date/time procedure performed (eProcedures.01).(134) Procedure performed prior to this unit's EMS care (eProcedures.02).(135) Procedure (eProcedures.03).(136) Number of procedure attempts (eProcedures.05).(137) Procedure successful (eProcedures.06).(138) Procedure complication (eProcedures.07).(139) Response to procedure (eProcedures.08).(140) Procedure crew members ID (eProcedures.09).(141) Role/type of person performing the procedure (eProcedures.10).(142) Protocols used (eProtocols.01).(143) Protocol age category (eProtocols.02).(144) Patient care report number (eRecord.01).(145) Software creator (eRecord.02).(146) Software name (eRecord.03).(147) Software version (eRecord.04).(148) EMS agency number (eResponse.01).(149) Incident number (eResponse.03).(150) EMS response number (eResponse.04).(151) Type of service requested (eResponse.05).(152) Primary role of the unit (eResponse.07).(153) Type of dispatch delay (eResponse.08).(154) Type of response delay (eResponse.09).(155) Type of scene delay (eResponse.10).(156) Type of transport delay (eResponse.11).(157) Type of turnaround delay (eResponse.12).(158) EMS vehicle (unit) number (eResponse.13).(159) EMS unit call sign (eResponse.14).(160) Level of care of this unit (eResponse.15).(161) Response mode to scene (eResponse.23).(162) Additional response mode descriptors (eResponse.24).(163) First EMS unit on scene (eScene.01).(164) Other EMS or public safety agencies at scene (eScene.02).(165) Type of other service at scene (eScene.04).(166) Date/time initial responder arrived on scene (eScene.05).(167) Number of patients at scene (eScene.06).(168) Mass casualty incident (eScene.07).(169) Triage classification for mild cognitive impairment (MCI) patient (eScene.08).(170) Incident location type (eScene.09).(171) Incident city (eScene.17).(172) Incident state (eScene.18).(173) Incident ZIP code (eScene.19).(174) Incident county (eScene.21).(175) Date/time of symptom onset (eSituation.01).(176) Possible injury (eSituation.02).(177) Complaint type (eSituation.03).(178) Complaint (eSituation.04).(179) Duration of complaint (eSituation.05).(180) Time units of duration of complaint (eSituation.06).(181) Chief complaint anatomic location (eSituation.07).(182) Chief complaint organ system (eSituation.08).(183) Primary symptom (eSituation.09).(184) Other associated symptoms (eSituation.10).(185) Provider's primary impression (eSituation.11).(186) Provider's secondary impressions (eSituation.12).(187) Initial patient acuity (eSituation.13).(188) Public safety answering point (PSAP) call date/time (eTimes.01).(189) Dispatch notified date/time (eTimes.02).(190) Unit notified by dispatch date/time (eTimes.03).(191) Unit en route date/time (eTimes.05).(192) Unit arrived on scene date/time (eTimes.06).(193) Arrived at patient date/time (eTimes.07).(194) Transfer of EMS patient care date/time (eTimes.08).(195) Unit left scene date/time (eTimes.09).(196) Patient arrived at destination date/time (eTimes.11).(197) Destination patient transfer of care date/time (eTimes.12).(198) Unit back in service date/time (eTimes.13).(199) Unit canceled date/time (eTimes.14).(200) Date/time vital signs taken (eVitals.01).(201) Obtained prior to this unit's EMS care (eVitals.02).(202) Cardiac rhythm/electrocardiography (ECG) (eVitals.03).(203) ECG type (eVitals.04).(204) Method of ECG interpretation (eVitals.05).(205) Systolic blood pressure (eVitals.06).(206) Diastolic blood pressure (eVitals.07).(207) Method of blood pressure measurement (eVitals.08).(208) Heart rate (eVitals.10).(209) Pulse oximetry (eVitals.12).(210) Respiratory rate (eVitals.14).(211) End tidal carbon dioxide (ETCO2) (eVitals.16).(212) Blood glucose level (eVitals.18).(213) Glasgow coma score-eye (eVitals.19).(214) Glasgow coma score-verbal (eVitals.20).(215) Glasgow coma score-motor (eVitals.21).(216) Glasgow coma score-qualifier (eVitals.22).(217) Total Glasgow coma score (eVitals.23).(218) Temperature (eVitals.24).(219) Level of responsiveness (AVPU) (eVitals.26).(220) Pain scale score (eVitals.27).(221) Stroke scale score (eVitals.29).(222) Stroke scale type (eVitals.30).(223) Reperfusion checklist (eVitals.31). Basic life support nontransport provider organizations that are paid or volunteer fire departments that render fire prevention or fire protection services to a political subdivision are not required to submit data under this rule.
(b) Each emergency medical services provider organization shall retain all records required by this title for a minimum of three (3) years, except for the following records that shall be retained for a minimum of seven (7) years:(1) Audit and review records.(2) Patient care reports.(c) An emergency medical service provider organization that has any certified vehicles involved in any traffic accident investigated by a law enforcement agency shall report that accident to the agency within ten (10) working days on a form provided by the agency.(d) Each provider organization, except basic life support nontransport provider organization, shall maintain accurate records concerning the assessment, treatment, or transportation of each emergency patient, including a patient care report form in an electronic or written format as prescribed by the commission as follows: (1) A patient care report form shall include, at a minimum, the following: (B) Identification number.(G) Address, including ZIP code.(H) Location of incident.(J) History, including the following: (i) Current medical condition and medications.(ii) Past pertinent medical conditions and allergies.(K) Physical examination section.(L) Treatment given section.(M) Vital signs, including the following: (iv) Level of consciousness.(v) Skin temperature and color.(vi) Pupillary reactions.(viii) Presence or absence of breath sounds.(ix) The time of observation and a notation of the quality for each vital sign.(N) Responsible guardian.(O) Hospital destination.(P) Radio contact via UHF or VHF.(Q) Name of patient attendants, including emergency medical service certification numbers and signatures.(R) Vehicle certification number.(S) Safety equipment used by patient.(U) Service delivery times, including the following:(i) Time of receipt of call.(iii) Time arrived on scene.(iv) Time of departure from scene.(v) Time arrived at hospital.(vi) Time departed from hospital.(vii) Time vehicle available for next response.(viii) Time vehicle returned to station.(2) The patient care report form shall be designed in a manner to provide space for narrative notation of additional medical information.(3) A copy of the completed patient care report form shall be provided to the receiving facility when the patient is delivered unless it is not feasible; however, the form shall be provided to the receiving facility not later than twenty-four (24) hours after the patient is delivered.(4) When a patient has signed a statement for refusal of treatment or transportation services, or both, that signed statement shall be maintained as part of the patient care documentation.(e) Each basic life support nontransport provider organization shall maintain, in a manner prescribed by the commission, accurate records, including a patient care report form, concerning the assessment and treatment of each emergency patient as follows: (1) A patient care report form shall be required by all basic life support nontransport provider organizations, including, at a minimum, the following:(B) Identification number.(F) Physician of the patient.(H) Address, including ZIP code.(I) Location of incident.(K) History, including the following: (i) Current medical condition and medications.(ii) Past pertinent medical conditions and allergies.(L) Physical examination section.(M) Treatment given section.(N) Vital signs, including the following: (iv) Level of consciousness.(v) Skin temperature and color.(vi) Pupillary reactions.(viii) Presence or absence of breath sounds.(ix) The time of observation and a notation of the quality for each vital sign.(O) Responsible guardian.(P) Name of patient attendants, including emergency medical services certification numbers and signatures.(Q) Vehicle emergency medical services certification number.(R) Responding service delivery times, including the following:(i) Time of receipt of call.(iii) Time arrived on scene.(iv) Time of patient released to transporting emergency medical services.(v) Time vehicle available for next response.(T) Safety equipment used by patient.(2) The report form shall provide space for narrative description of the situation and the care rendered by the nontransport unit.(3) A signed statement for refusal of treatment or transportation services, or both, shall be maintained as part of the patient care documentation.Indiana Emergency Medical Services Commission; 836 IAC 1-1-5; filed Jun 11, 2004, 1:30 p.m.: 27 IR 3512; filed Jul 31, 2007, 10:01 a.m.: 20070829-IR-836060011FRA; filed Oct 6, 2009, 4:19 p.m.: 20091104-IR-836080879FRA; readopted filed Jul 29, 2010, 8:07 a.m.: 20100825-IR-836100267RFAReadopted filed 10/31/2016, 1:48 p.m.: 20161130-IR-836160328RFAFiled 2/13/2019, 10:10 a.m.:20190313-IR-836180201FRAReadopted filed 7/24/2024, 3:48 p.m.: 20240821-IR-836230827RFA