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Introduction

The goal of the V3 Surveillance Dashboards is to provide the state data managers with an overview dashboard using nationally submitted data that allows them to observe trends in their state. This is done by examining two types of incidents:

  • Mass Casualty Incidents (single or multiple patients), and
  • National Influenza-Like Illness (ILI) Surveillance Dashboard

This user guide provides details on the ILI Symptoms dashboard.

At this time, the dashboard has been modified in response to the NHTSA request for the release of state and county data for the purposes of developing a national EMS syndromic surveillance system for COVID-19. As part of this data sharing, zip code and agency specific data have been removed from the dashboard. Once the data sharing period is complete, these data elements will return to the dashboard.


The NEMSIS National ILI Surveillance Dashboard includes, within the defined time frame, all EMS activations in which the Type of Service Requested [eRespsone.05] is a 9-1-1 response AND patient contact was made (eTimes.07 [Arrived at Patient Date/Time] is not blank OR eDisposition.12 [Incident/Patient Disposition] indicates a patient disposition that suggests patient contact occurred). An activation is an occurrence which initiates an EMS response with the potential of patient medical care. This is also referred to as an EMS “call” or “run”.

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 Surveillance Dashboards. For details on each element, its code, and range of values see the NEMSIS Version 3.4 Data Dictionary.

The criteria for including ICD-10-CM codes to represent influenza-like illness were drawn from guidance provided by the CDC, ILI dashboards provided by EMS Software Vendors, and codes utilized by EMS clinicians and archived in the National EMS Registry (i.e., internal validity monitoring).  The breadth of codes take into account the unique presentation of patients, coding variation found in available EMS software, and lack of definitive diagnosis capabilities in the pre-hospital environment. The inclusion criteria are intended to capture EMS interactions that could be consistent with an influenza diagnosis. This is not a COVID-19 specific dashboard.

For this dashboard, our inclusion criteria were as follows:

All NEMSIS records where a patient had a symptom or impression that was one of the following ICD-10 Codes:

Code

Description

B97.21

SARS-associated coronavirus as the cause of diseases classified elsewhere

B97.29

Other coronavirus as cause of disease

J00

Acute nasopharyngitis [common cold]

J09

Influenza due to certain identified influenza viruses

J09.X1

Influenza due to identified novel influenza A virus with pneumonia

J09.X2

Influenza due to certain identified influenza viruses with other respiratory manifestations

J09.X3

Influenza due to certain identified influenza viruses with gastrointestinal manifestations

J09.X9

Influenza due to certain identified influenza viruses with other manifestations

J10

Influenza due to other identified influenza virus

J10.00

Influenza due to other identified influenza virus with unspecified type of pneumonia

J10.01

Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia

J10.08

Influenza due to other identified influenza virus with other specified pneumonia

J10.1

Influenza due to other identified influenza virus with other respiratory manifestations

J10.2

Influenza due to other identified influenza virus with gastrointestinal manifestations

J10.8

Influenza due to other identified influenza virus with other manifestations

J10.81

Influenza due to other identified influenza virus with encephalopathy

J10.82

Influenza due to other identified influenza virus with myocarditis

J10.83

Influenza due to other identified influenza virus with otitis media

J10.89

Influenza due to other identified influenza virus with other manifestations

J11

Influenza due to unidentified influenza virus

J11.0

Influenza due to unidentified influenza virus with pneumonia

J11.00

Influenza due to unidentified influenza virus with unspecified type of pneumonia

J11.08

Influenza due to unidentified influenza virus with specified pneumonia

J11.1

Influenza due to unidentified influenza virus with other respiratory manifestations

J11.2

Influenza due to unidentified influenza virus with gastrointestinal manifestations

J11.8

Influenza due to unidentified influenza virus with other manifestations

J11.81

Influenza due to unidentified influenza virus with encephalopathy

J11.82

Influenza due to unidentified influenza virus with myocarditis

J11.83

Influenza due to unidentified influenza virus with otitis media

J11.89

Influenza due to unidentified influenza virus with other manifestations

J12

Viral pneumonia, not elsewhere classified

J12.0

Adenoviral pneumonia

J12.1

Respiratory syncytial virus pneumonia

J12.2

Parainfluenza virus pneumonia

J12.3

Human metapneumovirus pneumonia

J12.8

Other viral pneumonia

J12.81

Pneumonia due to SARS-associated coronavirus

J12.89

Other viral pneumonia

J12.9

Viral pneumonia, unspecified

J15

Bacterial pneumonia, not elsewhere classified

J15.0

Pneumonia due to Klebsiella pneumoniae

J15.1

Pneumonia due to Pseudomonas

J15.2

Pneumonia due to staphylococcus

J15.20

Pneumonia due to staphylococcus unspecified

J15.21

Pneumonia due to staphylococcus aureus

J15.211

Pneumonia due to Methicillin susceptible Staphylococcus aureus

J15.212

Pneumonia due to Methicillin resistant Staphylococcus aureus

J15.29

Pneumonia due to other staphylococcus

J15.3

Pneumonia due to streptococcus, group B

J15.4

Pneumonia due to other streptococci

J15.5

Pneumonia due to Escherichia coli

J15.6

Pneumonia due to other Gram-negative bacteria

J15.7

Pneumonia due to Mycoplasma pneumoniae

J15.8

Pneumonia due to other specified bacteria

J15.9

Unspecified bacterial pneumonia

J17

Pneumonia in diseases classified elsewhere

J18

Pneumonia, unspecified organism

J18.0

Bronchopneumonia, unspecified organism

J18.1

Lobar pneumonia, unspecified organism

J18.2

Hypostatic pneumonia, unspecified organism

J18.8

Other pneumonia, unspecified organism

J18.9

Pneumonia, unspecified organism

J20

Acute bronchitis

J20.1

Acute bronchitis due to Hemophilus influenzae

J20.2

Acute bronchitis due to streptococcus

J20.3

Acute bronchitis due to coxsackievirus

J20.4

Acute bronchitis due to parainfluenza virus

J20.5

Acute bronchitis due to respiratory syncytial virus

J20.6

Acute bronchitis due to rhinovirus

J20.7

Acute bronchitis due to echovirus

J20.8

Acute bronchitis due to other specified organisms

J20.9

Acute bronchitis, unspecified

J21

Acute bronchiolitis

J21.0

Acute bronchiolitis due to respiratory syncytial virus

J21.1

Acute bronchiolitis due to human metapneumovirus

J21.8

Acute bronchiolitis due to other specified organisms

J21.9

Acute bronchiolitis, unspecified

J22

Unspecified acute lower respiratory infection

Z20.828

Contact with and (suspected) exposure to other viral communicable diseases

Z20.9

Contact with and (suspected) exposure to unspecified communicable disease

Or where symptoms or impressions included two (or more) of the following ICD-10 codes:

Code

Description

J02

Acute pharyngitis

J02.0

Streptococcal pharyngitis

J02.8

Acute pharyngitis due to other specified organisms

J02.9

Acute pharyngitis, unspecified

J03

Acute tonsillitis

J06.9

Acute upper respiratory infection

J80

Acute respiratory distress syndrome

J98.9

Respiratory disorder, unspecified

M79.1

Myalgia

M79.10

Myalgia, unspecified site

M79.18

Myalgia, other site

R05

Cough

R06

Abnormalities of breathing

R06.0

Dyspnea

R06.00

Dyspnea unspecified

R06.01

Orthopnea

R06.02

Shortness of breath

R06.03

Acute respiratory distress

R06.09

Other forms of dyspnea

R06.8

Other abnormalities of breathing

R06.89

Other abnormalities of breathing

R06.9

Unspecified abnormalities of breathing

R07.0

Pain in throat

R09.81

Nasal congestion

R50

Fever of other and unknown origin

R50.8

Other specified fever

R50.81

Fever presenting with conditions classified elsewhere

R50.9

Fever, unspecified

R51

Headache

R53

Malaise and fatigue

R53.1

Weakness

R53.8

Other malaise and fatigue

R53.81

Other malaise

R53.83

Other fatigue

R68.83

Chills (without fever)

This dashboard offers two drop down filtering options, Unit Notified by Dispatch Date/Time (eTimes.03, as a slider) and Incident State (eScene.18). Information on other record specific elements can be found in the underlying data set, accessible though the Tableau tooltip. Data in the dashboard are from 10/1/2019 to present.


Elements of the Dashboard

This dashboard is divided into six topic areas distributed across three views, Trends, Patient, and Response. The visualizations associated with each view topic are outlined below.

ILI Activations

The ILI activations visualization 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 number displayed changes to show how many ILI activations are currently represented.

Hovering over the visualization displays the count of ILI-related activations selected as well as the total and the percent of the total.

Day and Time

Day of week and Time of Day

The day of week and time of day heat map shows the rate of ILI-related activations to all NEMSIS activations as a percent for the given day of week and time of day. This heat map can help pick out larger trends as ILI-related events become more or less common over time. A count of ILI-related activations for a given day and time can be found in the tooltip for this visualization. This time measure is based on Unit Notified by Dispatch Date (eTimes.03).

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

Trend Over Time

Trend of ILI Activations by Day

The trend of ILI activations by day visualization shows the daily trend and moving average of the ILI activations. Much like the month and year visualization, this is designed to help pick out spikes in ILI-related activations. The blue line shows the percent of ILI activations for each day, while the red lines shows a 14-day moving average. A count of ILI-related activations can be found in the tooltip.

Geography

Heat Map of ILI-Related Activations over the Total Number of EMS Activations

The heat map of ILI-related activations over the total number of EMS activations visualization displays a heat map of ILI-related activations by incident county (eScene.21). The color of each county indicates the rate of ILI-related activations for that county. The rate is defined as the number of ILI-related activations over the total number of EMS activations. The rates associated with each color are defined as green counties having a rate less than 6%, blue counties having a rate between 6% and 11%, orange counties having a rate between 11.1% and 15%, and red counties having a rate greater than 15%. This color scheme is anchored on the fact that the National average rate of ILI-related EMS activations during the Summer of 2019 was 6% and the National average rate during March of 2020 (during the COVID-19 outbreak) was 11%.

The tooltip for this visualization provides the name of the county, as well as the rate, the number of EMS activations, and the number of ILI-related activations.

Information on this map is available for all ILI-related activations where the user's state submitted the data. This may include counties outside the state, if the incident county was documented as outside the submitting state.

To use this map as a filter, click on the desired county, or use the map tools to draw a selection box over several areas. To exit the filter, click on the selection again.



Patient

Patient Encounter

The patient encounter topic provides three visualizations, age & sex, primary symptoms, and complaint reported by dispatch.

Age and Sex

The age and sex visualization displays the count of ILI-related activations that fall into the indicated age (ePatient.15 and ePatient.16) and sex groups (ePatient.13). The length of the bars represent higher numbers of patients, while color differentiates the two sexes. To use this visualization as a filter, simply click on the bar, age group or sex group you would like to filter on. To exit the filter, click on that item again.


Primary Symptom (Top 15)

The primary symptom visualization lists the top 15 most common reported primary symptoms (eSituation.09) for ILI-related activations. These symptoms are described using the code and description for the reported ICD-10CM code (see ICD-10 data for more information on these codes and descriptions). Darker colored cells indicate more activations for that specific primary symptom. Since some of the symptom descriptions are long, the tooltip can be used to bring up the full symptom description.

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


Complaint Report by Dispatch (Top 15)

This visualization displays the top 15 most common complaints reported by dispatch (eDispatch.01) for ILI-related activations. Darker colored cells indicate more activations for that specific complaint. Since some of the complaint descriptions are long and do not show, the tooltip can be used to bring up the full complaint description.

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




Response

Response Information

The response information section provides two visualizations, incident patient disposition and incident location type.

Incident/Patient Disposition (Top 15)

The incident/patient disposition (eDisposition.12) visualization lists all possible disposition choices, both by grouping as well as by the individual values. This is done to provide both an overview of the disposition, as well as the lowest level of detail captured by the NEMSIS standard. 

Darker colored cells indicate more activations for that specific disposition or group of dispositions.


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

Incident Location Type (Grouped)

This visualization shows distribution of the Incident Location Type (eScene.09) by the description given to the ICD-10CM code matching the first four characters of the recorded ICD-10CM code. E.g. The ICD-10CM code  Y92.000, with description "Kitchen of unspecified non-institutional (private) residence" was mapped the the ICD-10CM code Y92.0 with description "Non-institutional (private) residence" (see ICD-10 data for more information on these codes). This mapping provides a seven item list to concisely describe the incident location type, as opposed to a list containing hundreds of possible ICD-10CM choices.

Larger and darker colored cells in this list indicate more instances of that incident location type category. In some cases, the descriptions may not show because they are long, and the tooltip can be used to bring up the descriptions for these locations.

To use this visualization as a filter click on the 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 the NEMSIS 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
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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