ESO Launches 2021 ESO EMS Index to Track Nationwide Emergency Medical Services Performance Across Key Metric

Stroke assessment shows improvement; new metrics include weight documentation for ketamine administrations and non-transport dispositions

March 8, 2021 – AUSTIN, TexasESO, the leading data and software company serving emergency medical services (EMS), fire departments, hospitals and State EMS/Trauma offices, today announced the findings of its 2021 ESO EMS Index. The Index tracks performance of more than 2,000 EMS agencies nationwide across four metrics: stroke assessment, ketamine administration with patient weight recorded, lights and siren use, and non-transport of patients by EMS following a 911 call. Ketamine administration with patient weight recorded and non-transport disposition are new metrics added for the 2021 Index. 

Apart from performance measures, the 2021 Index includes two key surveillance measures. The Index continues to look at patients with suspected overdose, since calls related to overdose continue to climb significantly. Additionally, the Index combines COVID-19 and influenza-like impressions as differentiation in the out-of-hospital setting is difficult. 

“This is the fourth year of our annual EMS Index, and we are seeing how the use of data is having a positive impact for our customers and the communities they serve,” said Dr. Brent Myers, Chief Medical Officer for ESO. “In many ways, 2020 was a unique year due to COVID-19 and mainstream conversations around the use of ketamine. We’ve adjusted some of the metrics in the Index to be timely and relevant to current trends, concerns and conversations.”

Key Findings Include:  

    • Stroke Assessment Performance: When looking at the documented stroke assessment completion rate, we continue to see 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%).   
    • 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. 

“While it’s fantastic to see improvements across many of the metrics, we know there are still some areas that warrant further attention across the entire EMS landscape,” added Dr. Myers. “We are excited to continue partnerships with our customers and the industry to share data-driven knowledge that helps improve the health and safety of all our communities.” 

The full 2021 ESO EMS Index can be downloaded here

About the Index

The dataset from the ESO Data Collaborative 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 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. 

About ESO

ESO (ESO Solutions, Inc.) is dedicated to improving community health and safety through the power of data. Since its founding in 2004, the company continues to pioneer innovative, user-friendly software to meet the changing needs of today’s EMS agencies, fire departments, hospitals, and state EMS offices. ESO currently serves thousands of customers throughout North America with a broad software portfolio, including the industry-leading ESO Electronic Health Record (EHR), the next generation ePCR; ESO Health Data Exchange (HDE), the first-of-its-kind healthcare interoperability platform; ESO Fire RMS, the modern fire Record Management System; ESO Patient Registry (trauma, burn and stroke registry software); and ESO State Repository. ESO is headquartered in Austin, Texas. For more information, visit

Media Contact:
Andy Prince
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