Data Sharing Agreement Between the State of California Emergency Medical Services Authority

Data Sharing Agreement between the State of California Emergency Medical Services Authority (EMSA) and the University of Utah

Contract

This Data Use Agreement (the "Agreement") is entered into this 1st day of October, 2014 between the University of Utah, a body politic and corporate of the State of Utah, on behalf of its University of Utah Health Sciences Center (National Emergency Medical Services Information System (NEMSIS)) ("Data Recipient"), and State of California Emergency Medical Services Authority ("EMSA").

Recitals A. Data Recipient performs certain operations including the collection of EMS incident data in order to populate a National Emergency Medical Services (EMS) Database functions; and

B. EMSA (State of California Emergency Medical Services Authority) is engaged in activities involving the regulatory authority over such entities and possesses certain data in connection with that activity; and

C. EMS patient records and data related thereto, including paper and electronic versions of these records, maintained by the EMS Data Coordinator are confidential under California law (California Civil Code Section 56.10). However EMSA may permit access to these for special studies and analysis (California Civil Code Section 56.10(c) (7)). EMSA agrees to disclose a Limited Data Set (as defined for the NEMSIS Version 3 standard in Appendix v3) to Data Recipient for use by Data Recipient in performing the Activities (as defined below); and

D. Data Recipient agrees to limit its use of the Limited Data Set and protect the Limited Data Set according to the terms and conditions of this Agreement, and all applicable requirements of Health Information Technology for Economic and Clinical Health (HITECH) Act, HIPAA and the Privacy Rule (as defined below), as amended from time to time.

NOW THEREFORE, in consideration of the foregoing and other good and valuable consideration, the parties agree as follows:

1.0 DEFINITIONS. Capitalized terms used but not otherwise defined in this Agreement shall have the same meaning as those terms are defined in the Standards for Privacy of Individually Identifiable Health Information, 45 CFR part 160 and part 164, subparts A and E, as amended (the "Privacy Rule").

2.0 DISCLOSURE OF LIMITED DATA SET TO DATA RECIPIENT. 2.1 Scope of Limited Data Set. For purposes of this Agreement, the Limited Data Set shall consist of the following health information (the "Limited Data Set"): Information from EMS incidents occurring in the State of California, created by EMS professionals, and then submitted to the State of California's EMSA.

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 1 of 16 2.2 Disclosure of Limited Data Set. EMSA agrees to disclose the Limited Data Set to Data Recipient solely for use in connection with Data Recipient's responsibility to populate a National EMS Database with data from states from around the United States and related activities (the "Activities"), and Data Recipient agrees that it shall not use the Limited Data Set for any other purpose. Data Recipient further agrees that Data Recipient shall limit access to and the use of the Limited Data Set to the following individuals or classes of individuals who need the Limited Data Set in performing the Activities: See Appendix B for a List of Individuals and classes of Individuals.

3.0 OBLIGATIONS OF DATA RECIPIENT. 3.1. Use of Limited Data Set. Data Recipient (including without limitation its employees, officers, directors, and volunteers) shall not use or disclose the Limited Data Set except as permitted under the terms of this Agreement or as required by law.

3.2 Safeguards Against Misuse of Information. Data Recipient shall use appropriate safeguards to prevent use or disclosure of the Limited Data Set other than as permitted under this Agreement.

3.3 Reporting of Disclosures of Protected Health Information. Data Recipient shall notify EMSA of any use or disclosure of the Limited Data Set in violation of this Agreement by Data Recipient, its officers, directors, employees, contractors or agents, or by any third party, within one day of Data Recipient having knowledge of any such violation. Such notice shall be in writing and may be sent by fax to (916) 324-2875, email to [email protected], provided that any such notice shall also be sent to EMSA by personal delivery, certified mail, return receipt requested, or by nationally recognized overnight carrier to the following address: Director California EMS Authority 10901 Gold Center Drive, Suite 400 Rancho Cordova, CA 95670

CONFIDENTIAL

3.4 Use of Limited Data Set by Third Parties. Data Recipient shall ensure that its agents, contractors and subcontractors (collectively "Contractors") to whom it provides any portion of the Limited Data Set shall comply with substantially similar restrictions and conditions that apply to Data Recipient with respect to the use of the Limited Data Set and that no Contractor shall use or disclose such information except as permitted under the terms of this Agreement or as required by law. Data Recipient further agrees that it shall obtain and maintain, throughout the term of this Agreement, an agreement with each Contractor that has or will have access to the Limited Data Set by or through Data Recipient, under which such Contractor agrees to be bound by substantially similar restrictions, terms and conditions that apply to Data Recipient pursuant to this Agreement.

3.5 Identity of Individuals. Data Recipient agrees not to use the Limited Data Set in such a way as to identify any individual and further agrees not to contact any individual who may be a subject within the Limited Data Set.

3.6 Minimum Necessary Information. Data Recipient represents that Data Recipient's request that EMSA disclose Protected Health Information to Data Recipient is limited in scope to the minimum Protected Health Information necessary to accomplish Data Recipient's purpose in connection with the Activities. California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 2 of 16 3.7 Notice of Request for Data. Data Recipient agrees to notify EMSA within five business days of Data Recipient's receipt of any request or subpoena for Protected Health Information relating to this Agreement. Such notice shall be in writing and may be sent by fax to (916) 324- 2875, email to [email protected], provided that any such notice shall also be sent to EMSA by personal delivery, certified mail, return receipt requested, or by nationally recognized overnight carrier to the following address: Director California EMS Authority 10901 Gold Center Drive, Suite 400 Rancho Cordova, CA 95670

CONFIDENTIAL

To the extent that EMSA decides to assume responsibility for challenging the validity of such request, Data Recipient shall cooperate fully with EMSA in any such challenge.

4.0 STORAGE. All EMSA Records received shall be stored in a secure locked area with access restricted to project personnel for purposes as defined in agreement.

5.0 DESTRUCTION. All certificates and data received from EMSA shall be destroyed at the termination of the project or removed from the active national EMS data warehouse based on the Data Recipient’s standard practice., Destruction shall be by means which render the EMSA Records unidentifiable and useless. The Data Recipient shall provide notification to EMSA of the destruction of the records.

6.0 PUBLICATION. The Data Recipient, Contractor, or sub-contractor agrees to provide a copy of the proposed publication to EMSA at least thirty (30) days in advance of the proposed dissemination date if EMSA or other state data are specifically identified. The publication shall not be published in any format without the prior written consent of EMSA. The Data Recipient may publish data using the EMSA data with the understanding that all data are aggregate.

7.0 INDEMNIFICATION. The Data Recipient agrees to indemnify and hold harmless the State of California and EMSA, its officers, employees and agents appointed and elected and volunteers from any and all costs, expenses, losses, claims, damages, liabilities, settlements and judgments, including reasonable value of the time spent by the Attorney General's Office, and the costs and expenses and reasonable attorneys' fees of other counsel required to defend the State of California related to or arising from

• Any negligent, act or omission of the RECIPIENT or any its employees or volunteers,; •

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 3 of 16 • Notwithstanding the foregoing, RECIPIENT is as governmental entity of the State of Utah, subject to the rights and protections of the Utah Governmental Immunity Act, Utah Code Annotated 63G-7-101 et seq, as amended (Act). Nothing in this agreement shall constitute a waiver of RECIPIENT’s rights or protections under the Act. 8.0 AGREEMENT ADMINISTRATION. 8.1 Independent Contractor. The status of the Data Recipient shall be that of an independent contractor. The Data Recipient, its employees, agents and any subcontractors performing under this Agreement are not employees or agents of the State of California or any agency, division or department of the state. Neither the Data Recipient nor its employees shall be considered employees of the State of California for federal or state tax purposes. 8.2 Compliance with the Law. The Data Recipient and its employees and volunteers shall comply with all applicable federal, state, and local laws, rules, ordinances, regulations and orders when performing the services under this Agreement, including without limitation, all laws applicable to the release of California EMS Patient Registry data. The Data Recipient and its employees and volunteers shall also comply with all federal, state and local laws regarding business permits and licenses that may be required to carry out the work performed under this Agreement. 8.3 Amendments. This Agreement may be amended in writing from time to time by mutual consent of the parties. All amendments to this Agreement must be in writing and fully executed by the parties. 8.4 Third-Party Beneficiaries. There are no third party beneficiaries to this Agreement. This Contract is intended only to benefit the EMSA and the Data Recipient. 8.5 Choice of Law and Forum. The laws of the State of California shall govern and determine all matters arising out of or in connection with this Agreement. This provision shall not be construed as waiving any immunity to suit or liability including without limitation sovereign immunity in State or Federal court, which may be available to the State of California EMSA, or any California regent institution. 8.6 Assignment and Delegation. This Agreement may not be assigned, transferred or conveyed in whole or in part without the prior written consent of the other party. For the purpose of construing this clause, a transfer of a controlling interest in the Data Recipient shall be considered an assignment. 8.7 Integration. This Agreement represents the entire agreement between the parties. The parties shall not rely on any representation that may have been made which is not included in this Agreement. 8.8 Headings or Captions. The paragraph heading or captions used in this Agreement are for identification purposes only and do not limit or construe the contents of the paragraphs. 8.9 Supersedes Former Contract or Agreements. This Contract supersedes all prior Contracts or Agreements between the Data Recipient and the State of California, EMSA governing the use and transfer of EMSA data.

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 4 of 16 8.10 Notice. Any and all notices, designations, consents, offers, acceptances or any other communication provided for herein shall be given in writing by registered or certified mail, return receipt requested, by receipted hand delivery, by Federal Express, courier or other similar and reliable carrier which shall be addressed to each party as set forth as follows: 9.0 OWNERSHIP OF INFORMATION. Data Recipient acknowledges that, as between Data Recipient and EMSA, all Protected Health Information received or developed by Data Recipient in connection with this Agreement shall be and remains the sole property of EMSA, including any and all derivatives thereof developed by Data Recipient in performing its obligations under this Agreement, 10.0 TERM AND TERMINATION. 10.1 Term. The term of this Agreement shall commence as of the effective date set forth above and shall terminate in 3 years when all of the Protected Health Information provided by EMSA to Data Recipient, or created or received by Data Recipient on behalf of EMSA, is destroyed or returned to EMSA, or, if it is infeasible to return or destroy Protected Health Information, protections are extended to such information, in accordance with the termination provisions in this section. 10.2 Termination for Cause. Upon EMSA's knowledge of a material breach by Data Recipient, EMSA shall: (a) Provide Data Recipient with written notice of the breach and an opportunity to cure the breach within 30 calendar days of receipt of such notice. Data Recipient shall immediately take steps to mitigate the breach and shall cure the breach within the 30 day notice period. If Data Recipient fails to mitigate and cure the breach within the notice period EMSA may immediately terminate this Agreement; or (b) Immediately terminate this Agreement (without opportunity to cure) if EMSA determines, in EMSA's sole discretion, that Data Recipient has breached a material term of this Agreement; or (c) EMSA shall report the violation to the Secretary. 10.3 Effect of Termination. Upon termination of this Agreement, Data Recipient shall, upon the request of EMSA, either return or destroy all Protected Health Information received from EMSA, or created or received by Data Recipient on behalf of EMSA, and thereafter Data Recipient shall not retain any copies of such Protected Health Information. Notwithstanding the foregoing, to the extent that EMSA agrees that it is not feasible to return or destroy such Protected Health Information, the terms and provisions of this Agreement shall survive termination of the Agreement and such Protected Health Information shall be used or disclosed solely for such purpose or purposes that prevented the return or destruction of such Protected Health Information. 11.0 INJUNCTIVE RELIEF. Data Recipient agrees that the remedies at law for any breach by it of the terms of this Agreement shall be inadequate and that monetary damages from any such breach may not be sufficient or readily measured. Accordingly, in the event of any breach or threatened breach by Data Recipient of any terms of this Agreement, EMSA shall be entitled to immediate injunctive relief. EMSA’s right to injunctive relief shall not be an exclusive remedy and nothing herein shall prohibit EMSA from seeking all other available remedies. California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 5 of 16 12.0 MISCELLANEOUS. 12.1 Effect. The terms and provisions of this Agreement shall supersede any other conflicting or inconsistent agreements between EMSA and Data Recipient, including without limitation all exhibits or other attachments hereto and all documents incorporated herein by reference. Without limiting the foregoing, any limitation of liability or exclusion of damages provisions in any other agreement shall not be applicable to this Agreement.

12.2 Amendment. Data Recipient and EMSA agree to amend this Agreement to the extent necessary to allow either party to comply with the Privacy Rule, the Standards for Electronic Transactions (45 CFR Parts 160 and 162) and the Security Standards (45 CFR Part 142) (collectively, the "Standards") promulgated or to be promulgated by the Secretary or other regulations or statutes. Data Recipient agrees that it will fully comply with all such Standards and that it will agree to amend this Agreement to incorporate any material changes required by the Standards.

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 6 of 16 IN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their duly authorized representatives effective as of the day and year set forth above.

UNIVERSITY OF UTAH ("Data Recipient")

By: ______(Signature)

Name: Brian Watts, JD (Please Print)

Title: _ Chief Compliance Officer, University of Utah Health Sciences Compliance Services_

State of California EMSA ("EMSA")

By: ______(Signature)

Name: Howard Backer, MD. MPH, FACEP (Please Print)

Title: Director

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 7 of 16 Appendix v3 The NEMSIS Version 3 National EMS Elements To Be Collected From the State of California EMSA

The NHTSA / NEMSIS Version 3 standard consists of two Datasets. The national subset of requisite data [Limited Data Set] are the only elements that are sent from the State of California, Emergency Medical Services Authority (EMSA) to populate the NEMSIS Registry at the NEMSIS Technical Assistance Center. The Demographic Dataset represents information regarding the EMS Agency. The EMS Dataset represents information regarding the EMS activation / response. This may or may not include detailed incident, scene, patient, assessment, and treatment information depending on the disposition of the incident and/or patient. NHTSA / NEMSIS Version 3 – Requisite National Elements - Demographic DataSet - The NHTSA / NEMSIS Version 3 National Subset of data elements for the Demographic (EMS Agency) submission is listed below. A total of 35 elements comprise the Demographic Dataset (DEMDataSet). The three elements with a grey background will be submitted by the State Data Collection System to NEMSIS. The 32 remaining elements are specific to the EMS agency based on the licensure granted by the State EMS Office or other licensing authority. Blue typeface indicates the elements will be removed from public reporting.

NHTSA / NEMSIS NHTSA / NEMSIS Elements Removed V3 Element Number V3 Element Name from Public Reporting DEMOGRAPHIC (EMS Agency) REPORT Information dAgency Information 1 dAgency.01 EMS Agency Unique State ID Removed 2 dAgency.02 EMS Agency Number Removed 3 dAgency.04 EMS Agency State Removed 4 dAgency.05 EMS Agency Service Area States Removed 5 dAgency.06 EMS Agency Service Area County(ies) Removed 6 dAgency.07 EMS Agency Census Tracts Removed 7 dAgency.08 EMS Agency Service Area ZIP Codes Removed 8 dAgency.09 Primary Type of Service Public Data 9 dAgency.11 Level of Service Public Data 10 dAgency.12 Organization Status Public Data 11 dAgency.13 Organizational Type Public Data 12 dAgency.14 EMS Agency Organizational Tax Status Removed 13 dAgency.15 Statistical Calendar Year Removed 14 dAgency.16 Total Primary Service Area Size Removed 15 dAgency.17 Total Service Area Population Removed 16 dAgency.18 911 EMS Call Center Volume per Year Removed NHTSA / NEMSIS NHTSA / NEMSIS Elements Removed

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 8 of 16 V3 Element Number V3 Element Name from Public Reporting 17 dAgency.19 EMS Dispatch Volume per Year Removed 18 dAgency.20 EMS Patient Transport Volume per Year Removed 19 dAgency.21 EMS Patient Contact Volume per Year Removed 20 dAgency.25 National Provider Identifier Removed 21 dAgency.26 Fire Department ID Number Removed dConfiguration Information - This group repeats to allow for EMS Agencies licensed in multiple states to document the information specific to each state requirements. State Associated with the Certification/Licensure 22 dConfiguration.01 Levels Public Data 23 dConfiguration.02 State Certification Licensure Levels Public Data 24 dConfiguration.03 Procedures Permitted by the State Public Data 25 dConfiguration.04 Medications Permitted by the State Public Data 26 dConfiguration.05 Protocols Permitted by the State Public Data EMS Certification Levels Permitted to Perform 27 dConfiguration.06 Each Procedure Removed 28 dConfiguration.07 EMS Agency Procedures Removed EMS Certification Level Permitted to Administer 29 dConfiguration.08 Each Medication Removed 30 dConfiguration.09 EMS Agency Medications Removed 31 dConfiguration.10 EMS Agency Protocols Removed 32 dConfiguration.11 EMS Agency Specialty Service Capability Removed Emergency Medical Dispatch (EMD) Provided to 33 dConfiguration.13 EMS Agency Service Area Removed 34 dConfiguration.15 Patient Monitoring Capability(ies) Removed 35 dConfiguration.16 Crew Call Sign Removed

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 9 of 16 NHTSA / NEMSIS Version 3 – Requisite National Elements - EMS DataSet -

The NHTSA / NEMSIS Version 3 National Subset of data elements for the EMS Patient Care Report (ePCR/Event) submission is listed below. The elements below comprise the EMS Incident or Patient Care Report Dataset (EMSDataSet) submission information. Three DEMDataSet elements make up the header information specific to the EMS Agency. The actual ePCR/Event information consists of 130 or 131 elements.

Blue typeface indicates the elements will be removed from public reporting.

NHTSA / NEMSIS NHTSA / NEMSIS Elements Removed V3 Element Number V3 Element Name from Public Reporting HEADER - Demographic EMS Agency Information Group 1 dAgency.01 EMS Agency Unique State ID Removed 2 dAgency.02 EMS Agency Number Removed 3 dAgency.04 EMS Agency State Removed INCIDENT / PATIENT CARE REPORT (ePCR/Event) Information Group eRecord Information 1 eRecord.01 Patient Care Report Number Removed 2 eRecord.02 Software Creator Removed 3 eRecord.03 Software Name Removed 4 eRecord.04 Software Version Removed eResponse Information 5 eResponse.01 EMS Agency Number Removed 6 eResponse.03 Incident Number Removed 7 eResponse.04 EMS Response Number Removed 8 eResponse.05 Type of Service Requested Public Data 9 eResponse.07 Primary Role of the Unit Public Data 10 eResponse.08 Type of Dispatch Delay Public Data 11 eResponse.09 Type of Response Delay Public Data 12 eResponse.10 Type of Scene Delay Public Data 13 eResponse.11 Type of Transport Delay Public Data 14 eResponse.12 Type of Turn-Around Delay Public Data 15 eResponse.13 EMS Vehicle (Unit) Number Removed 16 eResponse.14 EMS Unit Call Sign Removed 17 eResponse.15 Level of Care of This Unit Public Data 18 eResponse.23 Response Mode to Scene Public Data 19 eResponse.24 Additional Response Mode Descriptors Public Data NHTSA / NEMSIS NHTSA / NEMSIS Elements Removed

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 10 of 16 V3 Element Number V3 Element Name from Public Reporting eDispatch Information 20 eDispatch.01 Complaint Reported by Dispatch Public Data 21 eDispatch.02 EMD Performed Public Data eTimes Information 22 eTimes.01 PSAP Call Date/Time Public Data 23 eTimes.03 Unit Notified by Dispatch Date/Time Public Data 24 eTimes.05 Unit En Route Date/Time Public Data 25 eTimes.06 Unit Arrived on Scene Date/Time Public Data 26 eTimes.07 Arrived at Patient Date/Time Public Data 27 eTimes.09 Unit Left Scene Date/Time Public Data 28 eTimes.11 Patient Arrived at Destination Date/Time Public Data Destination Patient Transfer of Care 29 eTimes.12 Date/Time Public Data 30 eTimes.13 Unit Back in Service Date/Time Public Data ePatient Information 31 ePatient.07 Patient’s Home County Removed 32 ePatient.08 Patient’s Home State Removed 33 ePatient.09 Patient’s Home ZIP Code Removed 34 ePatient.13 Gender Public Data 35 ePatient.14 Race Public Data 36 ePatient.15 Age Public Data 37 ePatient.16 Age Units Public Data ePayment Information 38 ePayment.01 Primary Method of Payment Public Data 39 ePayment.50 CMS Service Level Public Data eScene Information 40 eScene.01 First EMS Unit on Scene Public Data 41 eScene.06 Number of Patients at Scene Public Data 42 eScene.07 Mass Casualty Incident Public Data 43 eScene.08 Triage Classification for MCI Patient Public Data 44 eScene.09 Incident Location Type Public Data 45 eScene.18 Incident State Removed 46 eScene.19 Incident ZIP Code Removed 47 eScene.21 Incident County Removed eSituation Information 48 eSituation.01 Date/Time of Symptom Onset Public Data 49 eSituation.02 Possible Injury Public Data 50 eSituation.07 Chief Complaint Anatomic Location Public Data 51 eSituation.08 Chief Complaint Organ System Public Data NHTSA / NEMSIS NHTSA / NEMSIS Elements Removed

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 11 of 16 V3 Element Number V3 Element Name from Public Reporting 52 eSituation.09 Primary Symptom Public Data 53 eSituation.10 Other Associated Symptoms Public Data 54 eSituation.11 Provider’s Primary Impression Public Data 55 eSituation.12 Provider’s Secondary Impressions Public Data 56 eSituation.13 Initial Patient Acuity Public Data eInjury Information 57 eInjury.01 Cause of Injury Public Data 58 eInjury.03 Trauma Center Criteria Public Data Vehicular, Pedestrian, or Other Injury Risk 59 eInjury.04 Factor Public Data eArrest Information 60 eArrest.01 Cardiac Arrest Public Data 61 eArrest.02 Cardiac Arrest Etiology Public Data 62 eArrest.03 Resuscitation Attempted By EMS Public Data 63 eArrest.04 Arrest Witnessed By Public Data 64 eArrest.05 CPR Care Provided Prior to EMS Arrival Public Data 65 eArrest.07 AED Use Prior to EMS Arrival Public Data 66 eArrest.09 Type of CPR Provided Public Data Therapeutic Hypothermia Initiated 67 eArrest.10 (retired in v3.4.0) Public Data First Monitored Arrest Rhythm of the 68 eArrest.11 Patient Public Data 69 eArrest.12 Any Return of Spontaneous Circulation Public Data 70 eArrest.14 Date/Time of Cardiac Arrest Public Data 71 eArrest.16 Reason CPR/Resuscitation Discontinued Public Data 72 eArrest.17 Cardiac Rhythm on Arrival at Destination Public Data 73 eArrest.18 End of EMS Cardiac Arrest Event Public Data eHistory Information 74 eHistory.01 Barriers to Patient Care Public Data 75 eHistory.17 Alcohol/Drug Use Indicators Public Data eVitals Information 76 eVitals.01 Date/Time Vital Signs Taken Public Data 77 eVitals.02 Obtained Prior to this Unit’s EMS Care Public Data 78 eVitals.03 Cardiac Rhythm / Electrocardiography (ECG) Public Data 79 eVitals.04 ECG Type Public Data 80 eVitals.05 Method of ECG Interpretation Public Data 81 eVitals.06 SBP (Systolic Blood Pressure) Public Data 82 eVitals.08 Method of Blood Pressure Measurement Public Data 83 eVitals.10 Heart Rate Public Data NHTSA / NEMSIS NHTSA / NEMSIS Elements Removed V3 Element Number V3 Element Name from Public Reporting

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 12 of 16 84 eVitals.12 Pulse Oximetry Public Data 85 eVitals.14 Respiratory Rate Public Data 86 eVitals.16 End Tidal Carbon Dioxide (ETCO2) Public Data 87 eVitals.18 Blood Glucose Level Public Data 88 eVitals.19 Glasgow Coma Score-Eye Public Data 89 eVitals.20 Glasgow Coma Score-Verbal Public Data 90 eVitals.21 Glasgow Coma Score-Motor Public Data 91 eVitals.22 Glasgow Coma Score-Qualifier Public Data 92 eVitals.26 Level of Responsiveness (AVPU) Public Data 93 eVitals.27 Pain Scale Score Public Data 94 eVitals.29 Stroke Scale Score Public Data 95 eVitals.30 Stroke Scale Type Public Data 96 eVitals.31 Reperfusion Checklist Public Data eProtocols Information 97 eProtocols.01 Protocols Used Public Data 98 eProtocols.02 Protocol Age Category Public Data eMedications Information 99 eMedications.01 Date/Time Medication Administered Public Data Medication Administered Prior to this Unit’s 100 eMedications.02 EMS Care Public Data 101 eMedications.03 Medication Given Public Data 102 eMedications.05 Medication Dosage Public Data 103 eMedications.06 Medication Dosage Units Public Data 104 eMedications.07 Response to Medication Public Data 105 eMedications.08 Medication Complication Public Data Role/Type of Person Administering 106 eMedications.10 Medication Public Data eProcedures Information 107 eProcedures.01 Date/Time Procedure Performed Public Data Procedure Performed Prior to this Unit’s 108 eProcedures.02 EMS Care Public Data 109 eProcedures.03 Procedure Public Data 110 eProcedures.05 Number of Procedure Attempts Public Data 111 eProcedures.06 Procedure Successful Public Data 112 eProcedures.07 Procedure Complication Public Data 113 eProcedures.08 Response to Procedure Public Data Role/Type of Person Performing the 114 eProcedures.10 Procedure Public Data NHTSA / NEMSIS NHTSA / NEMSIS Elements Removed V3 Element Number V3 Element Name from Public Reporting eDisposition Information 115 eDisposition.05 Destination State Removed

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 13 of 16 116 eDisposition.06 Destination County Removed 117 eDisposition.07 Destination ZIP Code Removed 118 eDisposition.12 Incident/Patient Disposition Public Data 119 eDisposition.16 EMS Transport Method Public Data 120 eDisposition.17 Transport Mode from Scene Public Data 121 eDisposition.18 Additional Transport Mode Descriptors Public Data 122 eDisposition.19 Final Patient Acuity Public Data 123 eDisposition.20 Reason for Choosing Destination Public Data 124 eDisposition.21 Type of Destination Public Data 125 eDisposition.22 Hospital In-Patient Destination Public Data 126 eDisposition.23 Hospital Capability Public Data 127 eDisposition.24 Destination Team Pre-Arrival Activation Public Data Date/Time of Destination Prearrival 128 eDisposition.25 Activation Public Data eOutcome Information 129 eOutcome.01 Emergency Department Disposition Public Data 130 eOutcome.02 Hospital Disposition Public Data eOther Information Suspected EMS Work Related Exposure, 131 eOther.05 Injury, or Death Public Data

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 14 of 16 Appendix B Disclosure of NEMSIS Version 2.2.1 Limited Data Set By Means of the National EMS Database

For the purposes of using the data subset from the State of California, Emergency Medical Services Authority (EMSA), the following individuals or classes of individuals will have access to different levels of data.

All Data Sent by the California Emergency Medical Services Authority (EMSA) in its Raw Format

 University of Utah, Health Sciences Center, National EMS Information System Technical Assistance Center (NEMSIS TAC)

 National Highway Traffic Safety Administration (NHTSA) Office of EMS or the NHTSA’s National Center for Statistics and Analysis

Data Sent By the California Emergency Medical Services Authority (EMSA) and Used by the National EMS Database Reporting Engine. EXCLUSIONS: None. Including all data.

 The above entities

 The California, Emergency Medical Services Authority (EMSA)

Data Sent By the California Emergency Medical Services Authority (EMSA) and Used by the National EMS Database Reporting Engine. EXCLUSIONS: Any elements identifying a patient and zip codes of home, incident and hospital, EMS provider/agency, or receiving hospital (listed in Blue Typeface in Appendix v3 - The NEMSIS Version 2.2.1 National EMS Elements to Be Collected From the State of California).

 The above entities

 The public that can access the de-identified National EMS Database Reporting Engine’s website

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 15 of 16 Small Cell Size Limitations

Definitions:

Small Cell Size: A small cell size refers to the data contained within a particular data field that could potentially be used to identify an entity (individual or agency) because the number of cases in the field is few. For instance if only one emergency incident occurred in a particular zip code on a particular date, the data from the zip code field could potentially be used to identify an individual.

Small Cell Size Suppression: This is an accepted methodology used by researchers, reporters of data, and providers of data to prevent the identification of an entity. The cell size suppression provides a threshold for the minimum number of data that can be viewed within a particular field in a published report. For example, a general rule utilized by the NEMSIS TAC is that no data field is published in which less than 15 incidents are associated with that data field.

NEMSIS Technical Assistance Center's Policy on Cell Size Limitations:

The NEMSIS Technical Assistance Center (NEMSIS TAC) understands the value of data provided by the states to the National EMS Database. The NEMSIS TAC also understands that individual patients or EMS agencies should not be identified in any published reports it produces. Therefore, the NEMSIS TAC maintains a strict policy regarding cell size suppression. Reports that generate individual fields with less than 15 observations are either collapsed into a "parent fielded" or are excluded from the report.

California EMSA Data Sharing Agreement with University of Utah (NEMSIS) 2014 for NEMSIS Version 3 Limited Data Set Page 16 of 16