New 2021 ESO EMS Index Tracks Nationwide EMS Performance

Posted on April 1, 2021
Tags: EMS

In one of the strangest and most disruptive years in recent American memory, EMS professionals continued to suit up every day and face the COVID-19 pandemic head on. And just like the past three years, ESO continued to collect anonymous, real-world data from its agency partners to create its annual state of industry report, the 2021 ESO EMS Index.

Now in its fourth edition, the EMS Index was designed to serve as a point of reference for EMS organizations to identify which areas of their operations are in alignment, and which areas represent opportunity for improvement, more intensive local monitoring, or further assessment and evaluation. This quantitative approach to measuring performance gives EMS organizations a framework to continually refine tactics, improve efficiency and outcomes, and allocate resources appropriately.

The dataset used for the ESO EMS Index is real-world, de-identified data, compiled and aggregated from more than 2,000 agencies across the United States that use ESO’s products and services and that agreed to share their data for research purposes. This report is based on 8.8 million anonymized 911 encounters between January 1, 2020 and December 31, 2020, representing a full calendar year.

New for 2021

This year’s Index included updates to further quality improvement, such as adding patient weight documentation for ketamine administrations, as well as including characteristics of patients who were not transported by EMS. This year’s Index rotated out metrics for end-tidal carbon dioxide (EtCO2) after advanced airway procedure, 12-lead performance for adults with chest pain, and aspirin administration for adults with chest pain (though these metrics will most likely be added back in future editions). The Index continues to track two key surveillance measures: percent of patients suffering from overdose, and COVID-19/influenza-like illness (ILI) impressions.

While EMS agencies using the ESO EMS Index to evaluate their own operations should take into consideration factors such as the size of the population served, geographic location, and more – the key takeaways from this nationwide overview can provide a starting point or benchmark for evaluating performance compared to peers. For example, the Index can help agencies consider questions such as:

  • Is my organization performing similarly to other organizations around the country when it comes to best practices surrounding certain clinical presentations, such as stroke identification and assessment?
  • Are we above or below the national average when it comes to responding to overdose events?
  • Are we properly monitoring our use of ketamine in emergent situations?
  • Are we adequately equipped to handle a spike in flu-related calls (especially in light of the coronavirus)?
  • Are we practicing judicious use of lights and siren?
  • How do our responses ending in non-transport compare to the national average?
  • What are the best practices for each metric in this Index and how can I make sure we are following these at our organization?

Key Findings

Another benefit of the history of the Index is the ability to track trends over the past four years, not only examining this year’s performance, but making comparisons to the previous year’s data. The conclusions and best practices recommended in the Index are informed by several years of data, as well as the practical, firsthand experience of seasoned medical professionals. Key findings in the 2021 EMS Index include:

  • Stroke Assessment Performance: When looking at the documented stroke assessment completion rate, there was a continued steady performance from 2019 to 2020, as 71% of patients with suspected stroke had a documented assessment. The Cincinnati Prehospital Stroke Scale (CPSS) was most commonly used.
  • Ketamine Administration with Patient Weight Recorded: Recording patient weight is key to monitoring appropriate dosing. In 83% of cases, patients administered ketamine had their weight recorded in the EMS record.
  • Lights and Siren Use: EMS use of lights and siren must be judicious, as studies show that use of these emergency signals increase risk of ambulance crashes. Overall, most patients were transported without lights and siren (83%). However, this was a 4% increase compared to the previous year.
  • Non-transport Dispositions: During COVID-19, anecdotal reports described patient hesitancy to be transported to a medical facility. Overall non-transport dispositions represented 22% of all 911 encounters.
  • Percent of Encounters for Suspected Overdose: Encounters involving patients who experienced suspected overdose accounted for 2.7% of 911 calls in 2020, which is 9% higher than the 2.45% observed in 2019.
  • COVID-19 and Flu-Like Impressions: COVID-19 and Flu-like primary impressions accounted for 3.8% of all EMS encounters in 2020, with the majority occurring in March and April, and a resurgence in December. The correlation between the EMS impressions vs. CDC and other data reaffirms the accuracy of EMS impressions as a key component of overall surveillance.

While the improvements across many metrics were encouraging, the data still show areas that warrant further attention across the industry. These key findings allow individual agencies to look for similar trends in their own communities, and implement some of the recommendations and best practices connected to each key metric.

Data continues to be the number one tool for understanding the EMS industry, at both a national and local level. Knowing how to harness the power of your own data to draw conclusions, tell your data story, and make real-world, trackable improvements is key in taking your operations to the next level.

The full 2021 ESO EMS Index can be downloaded here.