Washington Emergency Care System Data Request

Washington Emergency Medical Services Information System and Washington Trauma Registry

Please complete the form below. Upon submission an Emergency Care System (ECS) Data Request Team staff will contact you within five (5) business days.

To inquire on the status of your request please email the team at ECSdatarequests@doh.wa.gov.

Question Title

* 1. Contact Infromation

Name

Organization

Role

Email Address

Phone Number

Question Title

* 2. Which data system are your requesting data from?

Washington Emergency Medical Services Information System (WEMSIS)

Washington Trauma Registry (WTR)

Question Title

* 3. Purpose of request

Quality Impovement

Research

Public Health Project

Other (please specify)

Question Title

* 4. Please briefly introduce your project. Include overarching goal and or research question that this data request is addressing.

Question Title

* 5. Is this a request for a one-time dataset/aggregate output or is this request for regularly updated data?

One time

Regular updated

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* 6. Type of data requested

Individual/Facility Level

Aggregate (state, county, etc.)

If this is an aggregate data request, please detail how the data is to be aggregated (i.e. responses by year or month for a specific region)

Question Title

* 7. Geographic region(s) of interest (i.e. WA state, region, county, etc.)

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* 8. Does the geographic region of interest correspond to the incident location, residence, or EMS service location? (Check all that apply)

Incident location

Residential location

EMS Service location

Other (please specify)

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* 9. Additional details about data request. List data selection criteria and data elements requested. For each data element identified, provide a justification of need/how it informs your project/research. WEMSIS data dictionary.
OR
Identify data product: County Level Opioid Analytic Dataset or Opioid Overdose Patient CQI Report.

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* 10. Please describe how you intend to use the requested data. Include any planned analysis, research methods, and anticipated sharing of findings. If you plan to link requested data to another existing data source, provide details here.

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* 11. When do you need this data by?

Date / Time

Date

Washington Emergency Care System Data Request

Washington Emergency Medical Services Information System and Washington Trauma Registry

Question Title

* 1. Contact Infromation

Question Title

* 2. Which data system are your requesting data from?

Question Title

* 3. Purpose of request

Question Title

* 4. Please briefly introduce your project. Include overarching goal and or research question that this data request is addressing.

Question Title

* 5. Is this a request for a one-time dataset/aggregate output or is this request for regularly updated data?

Question Title

* 6. Type of data requested

Question Title

* 7. Geographic region(s) of interest (i.e. WA state, region, county, etc.)

Question Title

* 8. Does the geographic region of interest correspond to the incident location, residence, or EMS service location? (Check all that apply)

Question Title

Question Title

* 10. Please describe how you intend to use the requested data. Include any planned analysis, research methods, and anticipated sharing of findings. If you plan to link requested data to another existing data source, provide details here.

Question Title

* 11. When do you need this data by?

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* 12. If this data is not able to be provided by the date listed above, what are the consequences to your program/research?

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* 13. If this request is not approved, what are the consequences to your program/research?