A recent study published in the journal Prehospital Emergency Care evaluates current approaches to measuring the performance of emergency medical services (EMS) across the United States and identifies new strategies that can improve the quality of care provided by EMS.
. Study: National evaluation of EMS performance at the responder and agency level. Image credit: blurAZ / Shutterstock.com
The evolution of EMS care guidelines
Across the US, a wide range of quality measures are used to measure the quality of care provided by EMS. However, compared to hospital-based or ambulatory medicine, there is still a lack of specific, nationally accepted, and evidence-based protocols for monitoring EMS and determining how to improve these services.
An earlier statement from the Consortium of US Metropolitan EMS Medical Directors in 2007 recommended the implementation of multiple quality control measures in the treatment of ST-elevation myocardial infarction (STEMI), seizures, pulmonary edema, cardiac arrest, and trauma. These quality control measures guided the appropriate management of these conditions prior to hospital arrival and how to select the appropriate hospital destination.
In 2015, the EMS Compass initiative published a set of quality measures jointly authored by the National Highway Traffic Safety Administration Office of EMS and the National Association of State EMS Officials. By 2018, the National EMS Quality Alliance (NEMSQA) had increased the range of stakeholders for this initiative, which ultimately led to the development of a set of evidence-based EMS quality measures that can be applied at scale to the EMS operating on the present in the United States.
These NEMSQA guidelines, released in 2019, include 11 quality measures covering eight areas of clinical management required in EMS.
The current study uses national EMS data to determine the use of these measures to assess the quality of EMS responses at the individual and agency levels. The dataset included 26.5 million responses performed by nearly 10,000 EMS operators.
Importantly, the current study is the first to determine how EMS agencies responded to nationally implemented quality measures.
What did the study show?
Performance varies by company type, size and response category. In the case of using lights and sirens, either when responding or transporting patients to the hospital, only 12% of EMS did not use lights and sirens compared to over 53% when transporting patients. With children, over 80% of cases diagnosed with respiratory distress by EMS were evaluated for respiratory distress and the results documented.
Approximately 60% of trauma patients were assessed for pain, only 16% of whom reported pain relief during the response process. Over 25% of patients with status epilepticus received benzodiazepines, the drug of choice, during the EMS response.
Organizational performance measures also varied widely. For pediatric cases, the agency’s performance was high at over 90%, while the safety ranking for these cases was 2%.
There were 22 agencies that had more than 100,000 patient calls, which accounted for one in seven of the 911 EMS responses throughout the study. Company size also affected performance, with smaller companies having a 60% yield for hypoglycemia compared to nearly 85% for larger companies with 25,000 to 100,000 runs.
There was no significant difference between urban and rural agencies in pediatric emergency response for six measures, including safety and trauma. Some differences were observed regarding the performance of agricultural agencies. However, these observations may not reflect clinical outcomes.
What are the consequences;
Quality of EMS care can vary significantly on some measures related to clinical and safety outcomes. Importantly, there is no formal standard by which performance can be classified as good or bad in this area. However, the current study found that over 50% of organizations performed below 35% on three of the six measures assessed. Instead, some performed almost 100%.
These findings provide a baseline against which to measure performance overall and track progress in the national picture.”
While it may not be ideal to achieve 100% performance on all measures, the study’s findings provide the basis for further research to establish benchmarks in these areas. Additionally, study findings can be reevaluated by comparing outcome-based versus process-based performance measures, thereby supporting the development of an evolving standardized set of measures that will improve EMS delivery.
