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Introduction

The goal of the v3 STEMI Dashboard is to provide the state data managers with an overview dashboard using nationally submitted data that allows them to characterize STEMI incidents in their state. This is done by examining several types of information:

  • Demographics
  • System Times
  • Scene
  • Transportation


Global Inclusion Criteria and Filters

The global inclusion criteria defines the minimum characteristics each event record must meet in order for it to be included in any of the calculations for the V3 STEMI Dashboard. For details on each element, its code, and range of values see the NEMSIS Version 3.4 Data Dictionary.

For this dashboard, our inclusion criteria were as follows:


eSituation.11 - Provider's Primary Impression

    • STEMI of anterior wall    I21.0 Or
    • STEMI of inferior wall     I21.1 Or
    • STEMI of other sites        I21.2

Or

eSituation.12 - Provider's Secondary Impression

    • STEMI of anterior wall    I21.0 Or
    • STEMI of inferior wall     I21.1 Or
    • STEMI of other sites        I21.2

Or

eVitals.03 - Cardiac Rhythm / Electrocardiography (ECG)

  • 9901051 STEMI Anterior Ischemia Or
  • 9901053 STEMI Inferior Ischemia Or
  • 9901055 STEMI Lateral Ischemia Or
  • 9901057 STEMI Posterior Ischemia Or
  • 9901021 Left Bundle Branch Block And
    • eSituation.11 - Provider's Primary Impression = Angina, I20.9 Or
      • Angina unstable I20.0

Or

eProtocols.01 - Protocols Used

    • 9914143 Medical-ST-Elevation Myocardial Infarction (STEMI)
And

eScene.19 - Incident Zip Code

    • A valid zip code for the location of the incident

And

eDisposition.07 - Destination Zip Code

    • A valid zip code for the location of the destination of the patient

And

Submitting State limited to the state the user has access to

The dashboard also includes a number of filters. These filters are defined as follows:

  • Unit Dispatch Date (eTimes.03):The date/time the responding unit was notified by dispatch

Elements of the Dashboard

This dashboard is divided into five sections, Data Set Size, Demographics, System Times, Scene, and Transportation, each outlined below.

Data Set Size

The Data Set Size section is designed to be a road map to help navigate this subset of EMS activations. As the user makes selections and filters on the data, the data set size bars will adjust to show how much of the data set is represented in a selection. As an example, if the "9-1-1 Response (Scene)" is selected for the Type of Service Requested  data set size visualizations would display the following:

The colored bars and label show that 5,88 activations and 673 EMS agencies. The black lines on the right size indicate the size of the full data set which, as of this writing, contains 8,540 activations and 758 EMS agencies.

For a state user, when the dashboard is opened, it will show that states data in relationship to the motor vehicle activations for the entire nation. Therefore, a state user will never see more than one state or territory listed in data set size.

Demographics

The Demographics section of this dashboard contains three visualizations, which display four metrics: age, gender, dispatch complaint, level of service.

Age and Gender Visualization

The Age and Gender visualization displays the percentages of total motor vehicle activations that fall into the indicated age (ePatient.15 and ePatient.16) and gender groups (ePatient.13). To see a count of activations, simply mouse over a cell in the table, and a tooltip will appear with more information on that grouping. For this table, darker color is indicative of a greater number of patients in the given group.

To use this visualization as a filter, simply click on the cell, row or column you would like to filter. To exit the filter, click on that cell, row or column again.

Dispatch Complaint

The Dispatch Complaint bar chart displays the percentage of total activations where a given complaint was reported to EMS dispatch (eDispatch.01).


Responding Agency Level of Service

The Responding Agency Level of Service treemap displays the percentage of total activations by the level of service which the agency provides EMS care for every request for service (the minimum certification level). This may be the license level granted by the state EMS office. (dAgency.11)

System Times

The System Times section looks at five time intervals of a normal EMS activation, Response Time, Scene Time, First 12 Lead ECG Time, Transport Time, and Transfer of Care Time. Times with a value 0 or less, as well as null values, are excluded from these visualizations. The system times are defined as follows:

  • Response Time: the duration in minutes between Unit En Route Date Time (eTimes.05) and Unit Arrived on Scene Date Time (eTimes.06).
  • Scene Time: the duration in minutes between Unit Arrived on Scene Date Time (eTimes.06) and Unit Left Scene Date Time (eTimes.09).
  • First 12 Lead ECG Time: the duration in minutes between the Unit Arrived on Scene Date Time (eTimes.06) and the first attempt at performing a 12 Lead ECG procedure (eProcedures.01). The 12 Lead ECG procedure is defined as one of the following SNOWMED CT procedure codes:
    • 268400002, 12 lead electrocardiogram (procedure)
    • 447113005, 12 lead electrocardiogram at rest (procedure)
  • Transport Time: the duration in minutes between Unit Left Scene Date Time (eTimes.09) and Unit Arrived at Destination Date Time (eTimes.10).
  • Transfer of Care Time: the duration in minutes between Patient Arrived at Destination Date/Time (eTimes.11) and Destination Patient Transfer of Care Date/Time (eTimes.12)

To change the visualization between the five system times, use the drop down menu (shown below). The bar chart will update accordingly. To use this visualization as a filter, click on the bar or the number of minutes, to exit the filter click on the bar or number again.

Scene Information

The Scene Information section looks at four displays of information on an EMS unit's interaction with the patient on scene: First Cardiac Rhythm, Medications, Procedures, and 12 Lead ECG.


First Cardiac Rhythm

The First Cardiac Rhythm table shows the distribution of the First Monitored Arrest Rhythm of the Patient (eArrest.11).

To use this visualization as a filter, click on any of the bars or titles, to exit the filter click on the bar or title again.

Medications

The Medications table shows the distribution of the top 10 Medications Given (eMedications.03). Medication names are derived from RxNorm (RXCUI) codes recorded by the EMS unit on scene.

To use this visualization as a filter, click on any of the bars or titles, to exit the filter click on the bar or title again.

12 Lead ECG?

The 12 Lead ECG binary distribution visualization enables the user to quickly filter the dashboard for activations where the 12 Lead ECG procedure was either performed, Yes, or not performed, No.

To use this visualization as a filter, click on any of the bars or titles, to exit the filter click on the bar or title again.

Procedures

The Procedures table shows the distribution of the top 10 procedures performed (eProcedures.03). Procedure names are derived from Snowmed (SNOWMEDCT) codes recorded by the EMS unit on scene.

To use this visualization as a filter, click on any of the bars or titles, to exit the filter click on the bar or title again.

Transportation

The Transportation section consists of three visualizations designed to provide more detail about the specific geographic information relating to STEMI-related EMS activations. These visualizations provide information on whether or not a PCI Alert was sent to the patient's destination, the distance traveled from the center of incident zip code to center of the patient's destination zip code, and the urbanicity (i.e. population density) of the incident location.

PCI Alert

The PCI Alert treemap displays the distribution of the accepted alert values for Destination Team Pre-Arrival Alert or Activation (eDisposition.24): Indication that an alert (or activation) was called by EMS to the appropriate destination healthcare facility team.

To use this visualization as a filter, click on the cell or the words "Yes" or "No".  To exit the filter, click on the cell or titles again.

Destination Distance

The Destination Distance visualization depicts information about the distance from the center of incident zip code to center of the patient's destination zip code. The map shows two different kinds of marks, a star to represent the destination zip code/hospital, and colored circles to represent incident locations. The tooltip for each mark gives some data on stroke events in each given zip code, including distance in straight line miles to the destination, number of records, average transport time, and average scene time. The star marks only give the destination zip code/hospital. To filter the rest of the dashboard on a specific incident location, click on the desired mark. To leave the filter click on the mark a second time.

To use this visualization as a filter, click on any of the bars or regions, to exit the filter click on the bar or region again.

Incident Urbanicity

The urbanicity tree map displays the percentage of activations occurring in each level of urbanicity as defined by the USDA Urban Influence Codes based on each activation's incident county (eScene.21).

To use this visualization as a filter, click on a cell. To exit the filter click on the cell again.

Tableau Toolbar

All Tableau dashboards share the same toolbar at the bottom of the view. Note that while most dashboards will have the same selections, some items may differ based on user permissions.

Undo, Redo, Revert, Refresh and Pause

These selections are found on the left side of the Tableau toolbar and can be used to help navigate the dashboard.


Undo will remove the last selection made, if you have used undo to remove a selection, you can then use redo to return to that selection. Revert returns the dashboard to its original view. Refresh will reload the data on the dashboard subject to any selections made. Pause will stop the dashboard from refreshing as you make selections.

As an example, if you want to make a set of complete selections in a dashboard’s filters, you could use these buttons to speed up the process. Normally, every time a change is made, the dashboard will refresh. If you select “Pause” however, the dashboard will remain the same no matter how many selections you make. Once you have made all your selections, you can select “Refresh” to reload the dashboard based on those selections.

Subscribe, Custom Views, Edit, Share, and Download

These selections are found on the right side of the Tableau toolbar and can be used to interact with the dashboard in external ways.


The Subscribe button allows users to subscribe to a daily or weekly email that will show a static image of the dashboard as well as a link to the view.

You can select either a particular view (tab) or all the views (tabs) available in the dashboard. Under “Email Subscriptions,” you can choose the frequency of emails. In “Subject Line,” you can assign the subject for the emails. As a default, the subscription will be assigned to the email address associated with your NEMSIS account.

Custom Views allows users to save any particular set of filters or selections for quick access later. A user can create their view and then name it and save it either for their own personal use or use by anyone with access to this dashboard. Previously saved views will appear in the custom views tab.

Edit will open the dashboard in the web editor for Tableau. Note that this option is not available on all dashboards and will require some knowledge of how to use Tableau to build and edit dashboards.

Share will provide a couple of options for sharing the dashboard with others, specifically an embed code and a regular HTML link. While you can use the link to share the dashboard with others, please keep in mind that many of the NEMSIS dashboards will require a username and password. Only those with credentials will be able to access them.

The last option is Download. Clicking on the download button opens up several options to download either the workbook, the data within it, or a static image of the view.

Selecting any one of these file types will produce a download of the requested file. Remember that not all options will be available for all dashboards and views.

Contact Info

Any questions, comments, concerns, or suggestions regarding this or other reports made available by the NEMSIS TAC, please contact us or leave a comment below!

Contact information is also available on our website.

Kevin White, BS
University of Utah School of Medicine
NEMSIS Technical Assistance Center
Phone: (801) 213-3408
Fax: (801) 581-8686
Email: kevin.white@hsc.utah.edu
Atim Effiong, MPH
University of Utah School of Medicine
NEMSIS Technical Assistance Center
Phone: (801) 585-9158
Fax: (801) 581-8686
Email: atim.effiong@hsc.utah.edu 
Laurel Baeder, BA, MStat
University of Utah School of Medicine
NEMSIS Technical Assistance Center
Phone: (801) 587-5337
Fax: (801) 581-8686
Email: laurel.baeder@hsc.utah.edu




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