ESO Launches 2022 ESO EMS Index to Track Nationwide Emergency Medical Services Performance Across Key Metrics

Report focuses on key metrics, including stroke assessment documentation and lights and siren usage; provides deeper insight into healthcare disparities

March 21, 2022 – AUSTIN, TexasESO, the leading data and software company serving emergency medical services (EMS), fire departments, hospitals, state and federal agencies, today announced the findings of its 2022 ESO EMS Index. The Index tracks data for more than 2,000 EMS agencies nationwide across both performance and surveillance measures: stroke assessment documentation, 12-lead electrocardiogram (EKG) acquisition for hospital-confirmed heart attack (STEMI/NSTEMI), ketamine administration with patient weight recorded and end-tidal carbon dioxide (EtCO2) documented, lights and siren use, non-transport of patients by EMS following a 911 call, encounters involving death notifications, and percent of patients with suspected overdose.

In addition to measures across EMS, this year’s Index takes a deeper look at a handful of measures across patient race/ethnicity and gender to identify disparities in response and treatment.

“This is the fifth year of our annual EMS Index, and we continue to see how agencies and departments are using data to make meaningful and deliberate decisions that have a positive impact,” said Dr. Brent Myers, Chief Medical Officer for ESO. “Additionally, we take a hard look at how, as EMS, we respond to our diverse patient population to identify where we have gaps and disparities when it comes to assessment and care for all members of a community.”

Key Findings Include: 

  • Stroke Assessment Performance: The data show a slight increase in the number of stroke assessments performed at 73 percent, up from 72 percent in 2020. However, when we break down stroke screening by patient race and ethnicity, we find variation in the rates of completed assessments.
  • 12-lead EKG with ED-diagnosed STEMI/NSTEMI: Approximately 70 percent of EMS patients who were diagnosed with a STEMI or NSTEMI in the emergency department had a documented 12-lead EKG. This indicates there is room for improvement in prehospital STEMI/NSTEMI identification.
  • Ketamine Administration with Patient Weight Recorded: In 83 percent of cases, patients administered ketamine had their weight documented 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 percent).
  • Non-transport Dispositions: Overall non-transport dispositions represented 16 percent of all 911 encounters, down from 22 percent in 2020.
  • Death Notifications: A substantial increase in on-scene deaths during COVID means that EMS clinicians delivered up to 47 percent more death notifications than pre-COVID. This includes patients for whom resuscitation was not attempted, or resuscitation efforts were terminated on-scene.
  • Percent of Encounters for Suspected Overdose: Encounters involving patients who experienced suspected overdose accounted for 2.6 percent of 911 calls, which is slightly lower than the 2.7 percent observed in 2020. However, on-scene death rates jumped 67 percent from pre-COVID.

“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 2022 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 9.9 million anonymized 911 encounters between January 1, 2021 and December 31, 2021, 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, state/provincial offices, and national/federal agencies. 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


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Andy Prince

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