CARES Schematron Rules - NEMSIS 3.5.0

myCARES Schematron Rules - NEMSIS 3.5.0 - updated 11/02/2023

We are currently developing a CARES-specific schematron. The schematron results are available via the File Upload Validation Report in the respective myCARES account.

Below is a list of current schematron ERROR/FATAL errors available for and in test on myCARES Beta. [FATAL] violations will trigger file rejection and are usually due to an incorrect format or value passed in an element. Because the file would fail at database level in these cases, we are now rejecting them before further parsing. Please check back often for updates.

You can access the current 3.5.0 myCARES Schematron here or refer to the below.

  • Date of Arrest is required - eArrest.14 must be present with a valid and non-empty date value. If these are not present, the value of eTimes.03 will be used. Missing eArrest.14 will produce a [WARNING] while improper value will produce a [FATAL] error.
  • The following NEMSIS elements are required by CARES and must be present with a value (no NV/nil, except where noted). Except where noted, these are [ERROR] or [WARNING] level:
    • Incident Number (eResponse.03) [FATAL] value required - file will fail in parsing without this, also it can`t be empty string and should be less than 50 characters.
    • Incident Address (eScene.15) - can`t be empty string.
    • Incident County (eScene.21) - can`t be empty string
    • Incident City (eScene.17) - can`t be empty string.
    • Incident State (eScene.18) - can`t be empty string. Also, it validates that the value corresponds to a valid state ID.
    • Incident Zip (eScene.19) - can`t be empty string
    • Location Type (eScene.09) - can`t be empty string
    • Location Type Other - now checks for Location Type (eScene.09) with Other (Y92.89) value.
    • First Responder (eScene.03 and eScene.24):
      • If any eScene.ResponderGroup contains eScene.03 but none of eScene.ResponderGroup elements contain eScene.24 = Yes (9923003), a warning will be issued.
      • If CPR was initiated by first responder (eArrest.20 is 3020007, 3020009, or 3020011), there must be a eScene.ResponderGroup with eScene.03 and eScene.24 = Yes (9923003), otherwise warning (for eTimes.03 < 1/1/24) or error (for eTimes.03 >= 1/1/24) will be issued.
      • If AED was first applied by first responder (eArrest.21 is 3021007, 3021009, or 3021011), there must be a eScene.ResponderGroup with eScene.03 and eScene.24 = Yes (9923003), otherwise warning (for eTimes.03 < 1/1/24) or error (for eTimes.03 >= 1/1/24) will be issued.
      • If the patient was first defibrillated by first responder (eArrest.22 is 3022007, 3022009, or 3022011), there must be a eScene.ResponderGroup with eScene.03 and eScene.24 = Yes (9923003), otherwise warning (for eTimes.03 < 1/1/24) or error (for eTimes.03 >= 1/1/24) will be issued.
      • Multiple eScene.ResponderGroup elements containing eScene.03 and eScene.24 = Yes (9923003) will produce a warning.
      • Time of First Responder Dispatched (FRDispatched) should not be documented if eScene.24 = No (9923001)
      • Time of First Responder Enroute (FREnroute) should not be documented if eScene.24 = No (9923001)
      • Time of First Responder Onscene (FROnscene) should not be documented if eScene.24 = No (9923001)
    • Patient Last Name (ePatient.02):
      • Ensure NV and PN attributes are documented
      • Ensure NOT Values is updated to Yes (remove CARES and NEMSIS values and replace with Yes)
      • Add Data Element Comment:
        • Any NV or PN sent will be imported in myCARES as "Doe".
    • Patient First Name (ePatient.03):
      • Ensure NV and PN attributes are documented
      • Ensure NOT Values is updated to Yes (remove CARES and NEMSIS values and replace with Yes)
      • Add Data Element Comment:
        • Any NV or PN sent will be imported in myCARES as "Jane" or "John".
    • Either Patient Age (ePatient.15/16, ePatient.15 must be a numeric value between 1 and 99) or Date of Birth (ePatient.17) - can`t be empty string
    • Patient Date of Birth (ePatient.17) - can't be empty string unless there is a DOB_Unknown element with the value of 1
    • Destination Hospital (eDisposition.02) - can't be empty string if End of Event is Pronounced Dead in ED or Ongoing Resuscitation in ED, must be empty/absent if End of Event is Pronounced in the Field or Effort Ceased Due to DNR
    • Patient Gender (ePatient.13) - can`t be empty string.
    • Patient Ethnicity (ePatient.14) - can`t be empty string.
    • Arrest Witness Status (eArrest.01 and eArrest.04):
      • eArrest.01 and eArrest.04 must be specified.
      • If Cardiac Arrest is documented (eArrest.01 is 3001005) but Arrest Witnessed By is not (eArrest.04 is 3004001 or NV), a warning (for eTimes.03 < 1/1/24) or error (for eTimes.03 >= 1/1/24) will be issued.
    • Presumed Cardiac Arrest Etiology (eArrest.02) - can`t be empty string.
    • Presumed Cardiac Arrest Etiology Other - now checks for Presumed Cardiac Arrest Etiology ID - 6 (3002011).
    • Resuscitation Attempted EMS (eArrest.03):
      • Requires confirmation if equals to 2 - '3003007', '3003009', '3003011' and eArrest.18 is 2 or 3 - '3018001', '3018005', '3018007', '3018009', '3018011'
      • Requires confirmation if equals to 2 - '3003007', '3003009', '3003011' and eArrest.07 is 5 - '3007005'
      • Requires confirmation if equals to 2 - '3003007', '3003009', '3003011' and custom element 911RespCPR is '1'
    • Resuscitation Attempted By 911 Responder (or AED shock given prior to EMS) (eArrest.03, eArrest.07, eArrest.20, eArrest.22)
    • Was an AED applied prior to EMS Arrival (eArrest.07):
      • Can`t be empty string
      • Requires confirmation if equals to 3007005 and eArrest.22 is 7701001 (Not Applicable)
      • Requires confirmation if equals to 3007005 and eArrest.22 is 3022013
      • Requires confirmation if equals to 3007003 and eArrest.22 is 3022001, 3022003, 3022005, 3022009, 3022007 or 3022011
      • Requires review if equals to 3007003 and eArrest.11 is 3011011, 3011013 or 3011009
      • If equals to 3007005 then eArrest.21 and eArrest.22 must match
    • Was Hypothermia provided in the field (eArrest.10) - can`t be empty string
    • First Arrest Rhythm of Patient (eArrest.11):
      • Requires confirmation if equals to 0('3011011') or 1('3011013') or 6('3011009') and FirstDefibPatient(eArrest.22) is 8('7701001')
    • Sustained ROSC (20 consecutive minutes), or present at end of EMS care (eArrest.12):
      • Sustained ROSC (eArrest.12) must be specified (not values, pertinent negatives, and nil are not accepted)
      • If Sustained ROSC is documented as "No" and "Yes" at the same time (multiple eArrest.12 elements with 3012003, 3012005, or 3012007 and at least one 3012001), a warning (for eTimes.03 < 1/1/24) or error (for eTimes.03 >= 1/1/24) will be issued.
      • If Sustained ROSC is documented as "Yes, Prior to Arrival at the ED" (eArrest.12 is 3012005), then another choice should also be documented using additional eArrest.12 with "Yes, At Arrival at the ED" (3012003) or "Yes, Sustained for 20 consecutive minutes". Otherwise, a warning will be issued.
      • If Sustained ROSC is documented as "Yes, Sustained for 20 consecutive minutes" (eArrest.12 is 3012007), then you must also document when ROSC occurred, using additional eArrest.12: at arrival at the ED (3012003) or prior to arrival at the ED (3012005). Otherwise, a warning (for eTimes.03 < 1/1/24) or error (for eTimes.03 >= 1/1/24) will be issued.
    • CARES End-of-event-related rules were improved to streamline import and match standard provider documentation.
      • If End of Event is documented as DNR in eArrest.16 and a conflicting choice in eArrest.18 a Warning (for eTimes.03 < 1/1/24) or Error (for eTimes.03 >= 1/1/24) will be produced.
    • Who Initiated CPR:
      • Value or NV = 7701001 is allowed
      • Value is required unless resuscitation was not attempted
      • Requires confirmation if equals to 7701001 (Not Applicable) and resuscitation was attempted
      • Requires confirmation if equals to 3020013 and eArrest.07 is 3007003 or 3007005
      • Requires confirmation if equals to 3020013 and eArrest.22 is 3022001, 3022003, 3022005, 3022009, 3022007 or 3022011
    • Who First Applied the AED (eArrest.21):
      • Required if eArrest.07 is Yes - (3007003 or 3007005)
      • Requires confirmation if AED was applied by first responder (3021007, 3021009, or 3021011) but patient was defibrillated by a lay person (eArrest.22 is 3022001, 3022003, or 3022005)
      • Requires confirmation if equals to 1('3021001') or 2('3021003') or 6('3021005') and LocationType(eScene.09) is 1('Y92.01')
    • Who First Defibrillated the Patient (eArrest.22):
      • Can`t be empty string
      • Schematron validation results gives the [ERROR] message if the "PN" attribute is present for eArrest.22
      • Requires confirmation if Not Value (7701001, 7701003) has been passed and custom element ROSCStart is 3 or 5
  • If used, the following optional custom elements must contain the proper value/format (can be omitted or nil). All of the below will constitute a [FATAL] violation, meaning the file will be rejected:
    • BystanderCPRProvidedID - schematron validation results gives the result with the [WARNING] if BystanderCPRProvidedID is 3.
    • CPRInstructionsProvided
    • 911RespCPR:
      • Can`t be empty string
      • Requires confirmation if documented as "No" (2) and ROSCStart is "After EMS CPR only" (4)
    • EndOfEvent - can`t be empty string
    • ROSCStart:
      • When EMS attempted resuscitation (eArrest.03 is 3003001, 3003003, or 3003005), ROSCStart = After Bystander CPR only (2) should not be documented
    • DefibTime
    • MechCPRDeviceID
    • CPRFeedbackDevice
    • DrugAdministration
    • ITDID
    • VascularAccessID
    • STEMI
    • EROutcome
    • Hypothermia_Provided_Hosp
    • HospOutcome
    • HospOutcomeDNR
    • EROutcomeTrans
    • HospOutcomeTrans
    • HospOutcomeDNRTrans
    • HospDispositionTrans
    • NeuroOutcomeTrans
    • Hypothermia_Provided_Hosp_Trans
    • MyocardialInfarction
    • CoronaryAngiography
    • CoronaryAngiographyDateTime
    • CardiacStent
    • CABGPerformed
    • ICDPlaced
    • HypoNotInitiatedHosp
    • DischargeDeathDateTime - can`t be empty string
    • TimeSusRosc
    • ResusAttemptResponder:
      • Requires values in eArrest.22 when eArrest.03 (Resuscitation Attempted By EMS) is 3003001 (Attempted Defibrillation)
      • Requires values in eArrest.20 when eArrest.03 (Resuscitation Attempted By EMS) is 3003003 (Attempted Ventilation) or 3003005 (Initiated Chest Compressions)

Test data sent to the Beta server should not contain any PHI.


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