This version of the State EMS Forms was posted on this site on 08/01/2010, and revised by the state on ----- .

The State of Oregon has engaged in two projects for 2008 in the development of their statewide prehospital data system. Per the 2009 Oregon Traffic Safety Performance Plan, "Both national and state advisory bodies have stressed the importance of pre-hospital data collection, and noted that Oregon’s lack of a pre-hospital data system is a barrier to both quality improvement and systems development activities. This pilot project will use Image Trend software for rural ambulance service data tracking and conforms to NEMSIS data guidelines."

Noted in the Oregon Administrative Rules filed through June 15, 2010:

333-250-0044

Prehospital Care Report Form or Electronic Field Data Format Completion Requirements

(1) The licensee must ensure that the service, employees, volunteers and agents meet the following:

(a) A PCRF must be initiated in each instance where an ambulance arrives on the scene and patient contact is initiated.

(b) A complete PCRF or electronic field data format as specified by the Division must be:

(A) Prepared by ambulance personnel and delivered to appropriate hospital staff at the time patient care is transferred;

(B) Except when providing PCRF via electronic format. Ambulance personnel are to verbally relay pertinent patient care information to hospital staff prior to leaving the hospital. A completed report must be submitted to the hospital at a location designated by the hospital within 12 hours or prior to the crew going off-duty, whichever occurs first.

(c) If the ambulance crew is unable to complete the PCRF at the time patient care is transferred, the ambulance crew may depart after receiving verbal verification from an emergency department employee involved with providing patient care that sufficient patient information has been transferred to support safe and timely continuation of patient care.

(d) The licensee must return the ambulance crew to the hospital when requested by the attending physician for the purpose of obtaining the completed PCRF or additional patient care information. If acceptable to the attending physician, a completed PCRF can be faxed or electronically sent to the hospital;

(e) A PCRF or electronic field data form must contain all data points as defined by version 2.2.1 of the National Highway Transportation Safety Administration Uniform Pre-Hospital Emergency Medical Services Dataset and required by the Oregon Prehospital Care Database.

(2) A completed PCRF or electronic field data form is not required when there is a disaster or a multiple patient incident consisting of more than five patients or the number of patients prescribed in the county's ASA plan, and which results in a single ambulance transporting two stretcher patients at the same time or when an ambulance is required to make more than one trip to and from the incident site. In those situations, a completed triage tag, that includes listing of the trauma systems identification bracelet number, recording of the times and results of all vital signs taken and the times, name and dosage of any medication given is acceptable patient care documentation. However, every reasonable attempt must be made by the ambulance personnel to complete an approved PCRF or electronic field data form for each patient at the conclusion of the incident.

EMS Statewide Data Collection for May, 2008

 The EMS & Trauma Systems Program (EMS/TS) requested information on each Prehospital Care Report for all EMS agencies for the month of May.   We thank you for your data, which we are now analyzing as part of designing a web-based EMS patient encounter data collection system. 

 If your agency has not yet submitted data, please do so as follows.

1.  a.  If you use a database which meets the NEMSIS 2.2.1 standard, you may submit an XML export.
    b.  You may submit a spreadsheet containing these datapoints (2008datapoints.xls )
    c.  You may duplicate all of the EMS Patient Care Report forms and mail them to our office.
2. Please identify any costs or barriers associated with complying with this request.   Costs and barriers might include the following:
   a.  Duplication and postage costs.
   b.  Difficulties in preparing a spreadsheet.
   c.  Time involved in preparing the information.
3. If your EMS agency is not able to provide the requested data, please
   a.  Identify the specific reasons that you are not able to provide the requested data. 
   b.  Identify the number of EMS patient encounters during May 2008.

Twelve-month Pilot PCR Project:

EMS/TS and the Oregon Office of Rural Health Policy (ORHP) are partnering in a one-year demonstration project to provide an electronic prehospital data collection system to rural EMS agencies.  This project will run through at least June 30, 2009.

The EMS & Trauma Systems Section and the Oregon Office of Rural Health have extended their demonstration project which provides an electronic prehospital data collection system to rural EMS agencies. The project will last at least through June 30, 2011.

Click on the thumbnails below to view a full sized image.

Select the following to view a printable Acrobat (.PDF) version. 

NHTSA EMS Re-assessment  3/2006 (.PDF, 181.83k)

PROPOSED Oregon PreHospital Data Points 5/2008 (.XLS, 26.00k)

Click on the following links to view the corresponding files:

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