Comments to Hospital AVailability Exchange (HAVE) from North Carolina, NEMSIS, and NASEMSO

["Greg Mears" <gdm@med.unc.edu>]

Greetings,

 

Comments provided in this email are voiced from the following entities:  the
National EMS Information System (www.NEMSIS.org), the North Carolina's
Hospital Preparedness Program (www.ncems.org), and the National Association
of State EMS Officials (www.NASEMSO.org <http://www.nasemso.org/> ).

 

These comments represent a detailed analysis and review of the proposed
standard with respect to use within the EMS and ESF-8 functions of state
government.  Although the structure of the EDXL is solid, there are many key
data elements which are missing and the definitions are often ambiguous.
Please see detailed comments below:

 

1.	The following data elements must be better defined for standardized
data.

 

*     Triage Patient Types including TriageRed, TriageYellow, and
TriageGreen.  Hospitals are not familiar with the field triage colors.  The
implementation of the SMARTT system (State Medical Asset Resource Tracking
Tool) which attempts to follow the HAvBED guidelines has better defined
these color based triage categories.  The brief definitions state that a Red
Patient is an ICU level patient, a Yellow Patient is a hospital floor bed
type of patient, and a Green Patient is considered in need of care but an
outpatient.  Please contact me if you would like the full definitions.

*     The definition of "Available Beds" must be better defined.  Typically
this is a staffed bed capable of accepting a patient at the time the data is
collected.  This would indicate that there is currently not a patient in the
bed.  The HAvBED definitions are acceptable in this area but not included in
this OASIS document.

*     There is a need for a more detailed definition of Bed Types.  Although
these definitions do include some detail, there is still too little detail
for hospitals to implement independently and consistently.  This is also
based on the rollout history of SMARTT.

*     The definition of CapacityStatus is to vague.  Please better define
VacantAvailable and NotAvailable.

*     The definition of BaselineCount is to vague.  Please define baseline.

*     The definition of ClinicalStatus is vague.  What is Level-1 Surge
Conditions, etc.

*     The definition of DeconCapacity is not helpful.  It should document
the number of ambulatory and non-ambulatory patients which can be
decontaminated over time (typically an hour)

*     MorgueCapacity should document the number of bodies it can accept
similar to bed status numbers.

*     Staffing is poorly defined.  Please define so a quantitative
measurement can be obtained or the data can be understood.

*     Status of Supplies is poorly defined.  Please define so a quantitative
measurement can be obtained or the data can be understood.  What is the
difference between facility and clinical operations?  Is a bed part of the
facility or clinical?

 

2.	The following data elements either need to be expanded or added to
provide more disaster or emergency operations information:

*     BedType should be expanded to include the following types:

o       Psychiatric Pediatric (99% of psychiatric beds will only accept
adults and our most significant challenge is finding adolescent psychiatric
beds).  We recommend splitting Psychiatric to Psychiatric-Adult and
Psychiatric-Pediatric.

o       Neonatal ICU Beds should be added.  This reflects a specialty area
not covered by Pediatric ICUs

o       Nursery Beds (non-Neonatal ICU) are a unique asset and skill set.

o       Rehabilitation/Long Term Care beds are an asset different from
Medical/Surgical beds.  Many hospitals have this capability but it should be
tracked separately.

*     ServiceCoverageStatus should be expanded to include the following:  

o       Cardiology should be divided to Cardiology-Invasive and
Cardiology-Non-invasive

o       Dialysis should be added

o       Emergency Department should be added

o       Hyperbaric Chamber should be added

o       Neurology should be divided to Neurology-Invasive and
Neurology-Non-invasive

o       Obstetrics/Gynecology should be divided to with and without Labor
and Delivery

o       Ophthalmology should be added

o       Pediatrics should be added

o       Psychiatry should be divided between adult and pediatric

o       Surgery specialties should be monitored including:  Adult General,
Cardiothoracic, Facial, Hand, Neurosurgery, Pediatric, Re-Implantation,
Spine, and Vascular

o       Transport Services including Air and Ground Specialty Care Transport
Services should be added

o       Trauma Center Status should be added.  Typically this would be Level
1, 2, 3, or 4

*     HospitalFacilityStatus should be expanded to include the following:

o       ED Visits should be monitored similar to admissions, discharges, and
deaths.

o       The number or supply of personnel protection equipment should be
monitored. This was key with the SARS outbreak and its management.  This
should include Level A, B, and C suits.  It should also track N95 masks at
the various sizes.

o       Pharmaceuticals Caches should be tracked. This included the
following drugs:

a.      Atropine

b.      British Anti-Lewisite (BAL)

c.      Ciprofloxacin

d.      Cyanide Kit or Cyanocoalbumin

e.      Doxycycline

f.        Diazepam and Lorazepam

g.      Mark 1 Kits

h.      Oseltamivir (Tamiflu) and Zanamivir (Relenza)

i.        Pralidoxime (2-PAM)

*     There should be some capability within the EDXL to include some custom
data within a standardized presentation.  This allows additional data to be
exchanged without breaking the EDXL schema and structure.  This would be the
equivalent to a comment filed on a form or database.  This is often best
implemented with two data elements.  One for the subject and one for the
data associated with the subject.  This is also a many to one allowing
multiple comments to be sent with a difference subject.

 

Thank you for the opportunity to provide these comments.  My contact
information is below should you need further clarification.

 

Greg Mears

 

 

________________________________

Greg Mears, MD

Associate Professor

North Carolina EMS Medical Director

The EMS Performance Improvement Center

 

Department of Emergency Medicine

University of North Carolina-Chapel Hill

100 Market Street

Chapel Hill, North Carolina  27516

919-843-0201

 <mailto:gdm@med.unc.edu> gdm@med.unc.edu