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Introduction

The goal of the V3 Surveillance Dashboards is to provide the state data managers with a 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
  • Flu Symptoms

This user guide provides details on the Flu Symptoms dashboard.

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.

For this dashboard, our inclusion criteria were as follows:

Flu Symptoms
all NEMSIS records where


This dashboard offers three drop down filtering options, Unit Notified by Dispatch Date/Time (eTimes.03, as a slider), and EMS Agency (dAgency.01, as a multi-select dropdown). Information on other record specific elements can be found in the underlying data set, accessible though the Tableau tooltip.


Elements of the Dashboard

This dashboard is divided into five sections, Data Set Size, Patient Demographics, Date and Time, Geography, and Other Event Information, 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. Hovering over the bars will display not only the count of activations selected, but the total and the percent of the total. Not that the black lines on the right side will always show the total data set size. For a state user, this will be the total number of Flu-related activations (or EMS agencies involved) in your state.

Patient Demographics

The patient demographics section of this dashboard contains a single visualization displaying patient age and sex.

Age and Sex

The age and sex visualization displays the count of Flu-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, are group or sex group you would like to filter on. To exit the filter, click on that item again.

Date and Time

The data and time section of the dashboard contains three visualizations showing Flu-related events over three different granularities of time.

Month and Year

The month and year heat map shows the rate of Flu-related activations to all NEMSIS activations as a percent for the given month. This heat map can help pick out larger trends as Flu-related events become more or less common over time. A count of Flu-related activations for a given month 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.

Day of Week and Time of Day

The day of week and time of day visualization, while very similar in appearance to the month and year visualization, looks at a different metric. The goal of this visualization is the find the "hot spots" during a week where Flu-related activations are most likely. Percentages are out of all Flu-related activations, rather than all NEMSIS activations. E.g. in the image above, 7.61% of all Flu-related activations occur on Sundays between 12pm and 6pm, while only 0.75% of Flu-related activations occur on Mondays and Thursdays between 12am and 6am. 

A count of Flu-related activations for each time period 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, click on the day of week, time block, or an individual cell. To exit the filter, simply click on the day, time, or cell again.

Trend of Flu Symtoms Rate by Day

The last visualization in the date and time section is a trend line of the flu symptom rate by day. Much like the month and year visualization, this is design to help pick out spikes in Flu-related activations. The blue line shows the flu symptom rate for each day, while the red lines shows a moving average over the previous two weeks. A count of flu-related activations can be found in the tooltip.

Geography

The geography section of this dashboard provides a dynamic map to help spot counties or zip codes with an abnormal rate of MCI-related activations.


MCI Rate Heat Map

The MCI Rate heat map offers a drop down selection to change the level of detail on the map. By default, the map opens to show the MCI rate by incident county (eScene.21), but the drop down can be used to increase the level of detail to incident zip code (eScene.19). The map is colored based on the MCI rate, blue counties (or zip codes) have a rate less than 2%, orange counties have a rate between 2% and 9%, and red counties have a rate above 9%.

The tooltip for this visualization provides the name of the county or zip code, as well as the rate, number of MCI-related activations, and a bar chart displaying the break down of single vs. multiple patient events.

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

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

Other Event Information

This last second of the dashboard contains scene and patient information for the MCI events. Much of this information is trauma-focused, as most MCI-related activations involve trauma. Not all elements displayed in this section may be relevant to all MCI-related activations. Be advised that counts for not values, or unknown/missing values have been omitted from most of these visualizations, so the counts may not add up to the total seen in the score card.

Complaint Report by Dispatch

This visualization lists the top 15 most common complaints reported by dispatch (eDispatch.01) for MCI-related activations. Darker colored cells indicated more activations for that specific complaint. Since some of the complaint descriptions are long, the tooltip can be used to bring up the full complaint description.

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

Incident Location Type

This visualization lists the Incident Location Type (eScene.09) by the description given to the ICD-10CM code matching the first for 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.

Darker colored cells in this list indicate more instances of that incident location type category.

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

Primary Symptom

The primary symptom visualization lists the top 15 most common reported primary symptoms (eSituation.09) for MCI-related activations. These symptoms are described using the 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 filter click on the description or the cell. To exit the filter click on the description or cell again.

Incident/Patient Disposition

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. When the dashboard opens, it defaults to the grouped view showing the following values: Assist, Canceled, Patient Dead at Scene, Patient Refused, Patient Released, Patient Treated and Transported, and Standby. To access the full list, click on the plus sign located in the column header. It will appear as you run your cursor over the header:

Darker colored cells indicate more activations for that specific disposition or group of dispositions. Since some of the disposition choices have long descriptions, the tooltip can be used to bring up the full description.


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

Probability of Survival

This visualization displays information on injury severity using a complex measure called the revised trauma score (or RTS) to calculate an approximate probability of survival. Patients who present with a probability of survival of 36.1% or less are considered severely injured and should be transported to a level 1 trauma center. In this visualization, those severely injured patients will appear in red cells. RTS is calculated as described in the box below, and its value translate to a probability of survival as described in the companion bar chart.

The probability of survival visualization uses counts to display the number of patients in each category, as there is a large bias toward less injured patients in the NEMSIS activations.

To use this visualization as a filter, click on any of the cells or percentages, to exit the filter click on the cell or percentage again.

Triage Classification for MCI Patients

The triage classification for MCI patients (eScene.08) visualization shows the percentage of MCI-related activations falling into each of the triage color categories: Green - Mininal (Minor), Red - Immediate, Yellow - Delayed, Grey- Expectant and Black - Deceased. These are represented in a tree map using the category colors, with size representing percentage of the total MCI-related activations. A count of MCI-related activations for each category can be found in the tooltip.

To use this visualization as a filter, click on any of the groupings, to exit the filter click on the grouping again.

Number of Patients

For the purposes of this dashboard and the NEMSIS standard, a MCI event is defined as "An event with injuries that may exceed the normal response capability of an emergency care provider agency." This visualization shows the Number of Patient at Scene (eScene.06) reported for each MCI-related activation. This information can also be found in the tooltip on the MCI heat map.

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

Responsiveness Level (AVPU)

The responsiveness level visualization shows a combination of Glasgow Coma Scores (eVitals.19, .20, .21) and AVPU scores (eVitals.26). For activations without a recorded Responsiveness Level (AVPU), GCS was scaled as follows to approximate an AVPU score: 


Alert (A)15-13 GCS
Verbal (V)12-9 GCS
Painful (P)8-5 GCS
Unresponsive (U)4-3 GCS




A count of MCI-related activations for each score can be found in the tooltip for this visualization.

To use this visualization as a filter, click on a pie slice. To exit the filter, click on the pie slice 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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