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Opioid Case Data

Monday, November 5, 2018
Reference: Updated Opioid Case Data

File 1:

MEDIA - Opioid Cases (2017-05-01 to 2018-09-30).xlsx

Date Range 5/1/2017 - 9/30/2018.

A summary table is on the first tab.

ALL case data is on the second tab.

Resuscitation/Death case data is on the third tab.

Summary stats are on the fourth tab.

Fields, including a breakdown of what “OTHER” patient primary impressions are, is on the last tab.

The “FEMS INC” number (indexed) is now common across both data tabs. If you see a duplicate value, it means more than one patient was transported from the incident.

File Set 2:

Opioid Usage Heat Maps

These maps indicate the highest areas of concentration of Opioid use in the District of Columbia

Thursday, September 27, 2018
Reference:
Opioid Case Data

File 1:
MEDIA - Opioid Cases (2017-05-01 to 2018-09-17.xlsx

Date Range 5/1/2017 - 9/17/2018.

A summary table is on the first tab.

ALL case data is on the second tab.

Resuscitation/Death case data is on the third tab.

Summary stats are on the fourth tab.

Fields, including a breakdown of what “OTHER” patient primary impressions are, is on the last tab.

The “FEMS INC” number (indexed) is now common across both data tabs. If you see a duplicate value, it means more than one patient was transported from the incident.

File 2:
Opiod Cases TABLE and MAPS (2017-05-01 to 2018-09-17).pdf

File 3:
Opioid Cases 3D CHARTS (2017-05-01 to 2018-09-17).pdf


Files 2 and 3 are Working Analysis maps and charts which provides a geospatial “picture” of the data without coding to GIS. Total case count on the maps is 14 less than overall case count because a Grid ID could not be identified for the incident. Note that 100% of opioid cases occur in less than 33% of the District. Beginning on Page 6 of this attachment, you’re going to see “hot spots” (by grid box) begin to light up. Notice the percentage of cases vs. percentage of surface area. These are “cluster” locations. All 3D columns are to identical scale (and comparable). 

File 4:
Media SAMPLE DATA.png


PNG image of a sample data map (random data). If you zoom in on this, you’ll see the detail clearly. Each point is a “case.” This is the resolution and “point” size we can produce in a monthly range. 


Thursday, July 5, 2018
Reference: Opioid Case Data

The data coverage period that can be produced is from 5/1/2017 to 4/30/2018 (the most recent 12 month period). Beginning on May 1, 2017, FEMS switched to the NEMSIS V3 “standard” patient care reporting (PCR) data set. All of this data uses this new format. Prior to May 1, 2017, FEMS was using an “older” version without standardized field choices and data. Accordingly, producing queries using the old data is much harder and less accurate. Comparative V3 NEMSIS data from other states, which includes the data attached to this transmission (without geospatial identification) can be accessed by visiting the NEMSIS Research Data site.

To be included in this data, a patient case MUST have a “primary” or “secondary” EMT/Paramedic indicated “impression” of “opioid related disorders.” This is a standardized data field choice (please click this link, see section E9, “Situation”, Pages 2 and 3). A “primary” impression means an EMT/Paramedic examined the patient and suspected that an opioid was “primarily” causing or contributing to the patient’s medical condition such that he or she needed EMS services. Such an “impression” is based on physical exam and patient history, generally what the EMT/Paramedic heard, saw or needed to do when treating the patient. It may or may not be accurate. A “secondary” impression is generally a “contributing” factor.

For example, a patient may be treated for a “fall” with a serious injury (say, a bleeding facial laceration/fractured nose). The “primary” impression would be “injury from a fall,” but if the EMT/Paramedic determined the patient was using an opioid product that caused the fall (i.e., the patient suddenly became unconscious while standing and then fell), “opioid related disorders” may be indicated as a “secondary” impression which contributed to the fall. Accordingly, both categories have been merged into this data set. Please understand there is a likely degree of inaccuracy in this data. If an EMT/Paramedic did NOT chose “opioid related disorders” as a “primary” or “secondary” impression, but instead only included it in the PCR narrative (using description), the record would NOT be included in this data set.

Considering the above, there were 1,904 “suspected opioid cases” which FEMS treated and/or transported during the 12 month period of 5/1/2017 to 4/30/2018. The average case rate during the time period was 5.2 per day, with 90% of days experiencing 9 cases or fewer (MAX = 15 on 2 days, MIN = 0 on 8 days). Of these 1,904 “suspected opioid cases,” 20 were pronounced “dead” in the field, either immediately or after attempted resuscitation. An additional 13 were transported to a hospital after receiving CPR or with CPR in progress.

Of these 1,904 “suspected opioid cases,” 668 (or 35%) received one or more doses of Naloxone (Narcan). Naloxone is often NOT used if the patient’s respiratory effort is adequate and the patient is coconscious. For the 22 patients who experienced attempted resuscitation with CPR, and were either pronounced dead after attempted resuscitation or transported to a hospital, 18 (or 82%) received Naloxone. The patients NOT receiving Naloxone in these cases (4 out of 22) were “briefly” attempted resuscitation cases when a Paramedic pronounced the patient dead prior to ALS procedures (attempted resuscitation was started by a BLS (EMT) crew, prior to a Paramedic arriving).

FILES

File 1:
Opioid Cases TABLE and MAPS (2017-05-01 to 2018-04-30).pdf
Summary table of data with comparative working maps (for reference).

The “Opioid Cases TABLE and MAPS” attachment is a summary picture of the data. Page 1 shows overall counts. On the left are all cases. On the right (a subset of data on the left) are attempted resuscitation (CPR was performed) and pronounced death cases. The three pages that follow are “working maps” (not using GIS) showing the geospatial distribution of cases. These are “reference maps” for the WP analytics staff (the results they produce should be co-located if done correctly). The small “boxes” on each map represent a 300 meter by 300 meter (300m x 300m) area of the District.

In all, the District is covered by 2,085 of these boxes. Thus, each “box” is 1/2085th of the District’s total geographic area. Page 3 shows geospatial distribution of all cases (n = 1,904). Approximately 20% (or 1 out of 5) “suspected opioid cases” occur in just more than 1% (or .8 square miles) of the District. Similarly, approximately 50% (or 1 out of 2) cases occur in 5% (or 3.4 square miles), while 90% occur in less than 20% (or 13.6 square miles) of the District. Page 4 shows geospatial distribution of cases that received Naloxone (n = 668), while Page 5 shows geospatial distribution of cases that experienced attempted resuscitation with CPR and were either pronounced dead after attempted resuscitation or transported to a hospital (n = 33).

File 2:
Opioid Cases (2017-05-01 to 2018-04-30).xlsx
Data file of suspected opioid cases with geospatial identifiers.

The “Opioid Cases” attachment is the raw record data with summary stats. The first tab (dark blue) is ALL data. The incident number has been “indexed,” but is consistent with other tabs (duplicate values indicate more than one patient transport from the same incident). The second tab (red) is a subset of the first tab and ONLY includes records for patients who experienced attempted resuscitation with CPR and were either pronounced dead after attempted resuscitation or transported to a hospital. The third tab (light blue) is summary statistics for the first tab (ALL patients). The fourth tab (gray) defines data fields.

File 3:
300M Grid Map.pdf
Reference map of FEMS geospatial grid system.
The “300M Grid Map” attachment is an overview map of grid layout for reference.

File 4:
399MG.LPK
Shape file of FEMS geospatial grid system.

Mortality Cases
Just because FEMS transported a patient that did not need (CPR) during treatment, doesn’t mean the patient subsequently survived hospitalization. A number of serious opioid cases receive advanced treatment by FEMS personnel and arrive unconscious at a hospital. These patients may not survive.

Similarly, for opioid patients receiving resuscitation (CPR) during treatment, they may still die after arriving at a hospital.

In all of these cases (considered “mortality” cases), DOH and the Medical Examiner’s Office remain the source for outcome level (mortality) data. Both agencies submit mortality data to the CDC’s National Health Center for Statistics [cdc.gov] which reports leading causes of death and age based trends nationwide.

Drug overdose deaths (with CDC data sets) can be found by clicking on this link [cdc.gov] and specifying “District of Columbia” in the data