ESO Releases 2024 EMS Index to Explore Key Trends and Measures Affecting EMS Agencies across the Country

Index adds pain management for patients with long bone fractures and takes a deep dive into opioid overdose and bystander CPR

April 24, 2024 – AUSTIN, Texas – ESO, a leading data and software company serving emergency medical services (EMS), fire departments, hospitals, state and federal agencies, today announced the findings of its 2024 EMS Index. The Index tracks data for more than 3,000 EMS agencies nationwide across clinical performance and public health surveillance measures: pain management for long bone fractures, patient offload time, bystander CPR, critical incident reporting, and patients with suspected opioid overdose who were treated in place by EMS.

“Since launching our first ESO EMS Index, we’ve seen how EMS agencies are using data to make meaningful and deliberate decisions that have a positive impact,” said Dr. Brent Myers, Chief Medical Officer at ESO. “This year, we’ve introduced several pivotal measures that are impacting the EMS industry, such as patient offload time, commonly known as ‘wall time.’

“This metric was developed in response to discussions about the delays patients sometimes face at the hospital before care is transferred over to the emergency department staff,” continues Myers. “While a significant majority of patient offload times fall within 20 minutes, our data reveals that over 10% wait between 20 minutes up to an hour. These delays not only jeopardize patient well-being and satisfaction but also strain resources within the EMS system.”

Key Findings Include:

    • Opioid overdose and treatment: Nearly 2% of all 911 records in 2023 were for patients with suspected opioid overdose. Over half of patients receiving naloxone received more than one dose, raising concerns related to potency of opioids.
    • Pain medication administration for patients with long bone fractures: Despite EMS documentation of severe pain, only 73% of patients with long bone fractures confirmed in the hospital were administered prehospital analgesics with the number even lower for Black or African American patients at 63%.
    • Ambulance patient offload times: 88% of patient offload times fell within 20 minutes.
    • Bystander CPR: Out of the 112K patients who suffered a cardiac arrest prior to EMS arrival, fewer than one in four patients (22%) received bystander CPR. Black patients received bystander CPR even less frequently at 17%.
    • Critical incidents reporting: Our industry continues to improve focus on provider health; there were more than 6.2K incidents reported by crews that had a significant impact on their personnel well-being, ranging from cardiac arrest to prolonged rescues.

“This year we’ve seen some fantastic improvements compared to our 2023 numbers, but also areas that warrant further attention across the entire EMS landscape,” added Dr. Myers. “In 2023, 25% of cardiac arrest patients received bystander CPR, but in 2024, this trend moved slightly in the wrong direction, down to 22%. If we look by race, Black or African American patients received bystander CPR least often at 17%, followed by Hispanic or Latino patients at 22%. This tells us that agencies should consider identifying communities with low rates of bystander CPR and provide outreach in those areas.”

The full 2024 ESO EMS Index can be downloaded here.

About the Index
The Index uses data from the ESO Data Collaborative, comprised of more than 3,016 departments across the country, representing more than 12 million EMS responses between January 1 – December 31, 2023.

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 and federal 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:
Kaitlyn Karmout
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