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The Index Mid-Year Update: How Does Your Agency Compare?”

ESO Staff

Earlier this year, we launched the first-ever ESO EMS Index to look at five key metrics that affect EMS agencies across the country. We looked at more than 5 million patient encounters from January 1, 2017 – December 31, 2017.

The five metrics we measured for are: 1) Stroke assessment performance; 2) percent of patients suffering from overdose; 3) ETCO2 after advanced airway procedure; 4) 12-lead performance in adult chest pain; and 5) aspirin administration in adult chest pain.

We’ve since published a mid-year update to the Index with looking at the same five metrics but with more recent data, looking at 3 million+ patient encounters from January 1, 2018 – June 30, 2018. We also refined our stroke metric to ensure greater accuracy and precision.

Here are the results:

Stroke Assessment Performance: We’ve modified our stroke metric to account for the additional screening tools being employed. Additionally, we are focused only on 9-1-1 patients and not interfacility transfers and other types of patients. What you’ll see in the numbers is a change from 50.5% in the Index we launched earlier this year to 63% for the first half of this year (2018). The improvement cannot be completely explained by modifications in the reporting mechanism — the good news is we also see improvement in performance. We are encouraged that the interim report demonstrates clinically meaningful improvement in stroke assessment documentation.

Percent of Patients Suffering from Overdose: The opioid epidemic continues to be a serious problem in this country. We found that approximately 1.67% of all the 3M+ calls in the first half of 2018 were related to overdose (this is up from 1.65% in 2017). That’s not a small number, and the problem is only getting worse.

ETCO2 After Advanced Airway Procedure: The measurement of exhaled carbon dioxide, referred to as end-tidal CO2 (ETCO2) following advanced airway placement, is an industry best practice and should be measured in every agency. The use of ETCO2 monitoring confirms proper placement, can alert the provider of accidental dislodgement, and the second-by-second wave form provides definitive proof that the tube remained in place during the encounter. The good news is that in 96% of advanced airway cases, EMS providers are following this ETCO2 best practice (up from 94.5% in 2017).

12-Lead Performance in Adult chest Pain: The EKG is one of the most powerful tools an EMS provider has at their disposal, allowing EMS providers to screen for cardiac ischemia, and especially for acute ST-elevation myocardial infarction. Measureable and reproducible reductions in mortality are associated with appropriate acquisition and interpretation of EMS EKGs. We see an improvement in 2018 so far, where 80% of cases where non-traumatic chest pain was identified as a primary impression in individuals over the age of 35 was a 12-lead EKG used (the number was 75.9% in 2017).

Aspirin Administration in Adult Chest Pain: The aspirin administration for chest pain metric looked at the number of patients over the age of 35 with a primary impression of non-traumatic chest pain that received aspirin or had a documented aspirin allergy. With aspirin playing such an important role in helping reduce deaths from acute coronary syndrome, it continues to be an eye opener to see that in only 52% of cases was aspirin protocol followed (this is down from 55.3% in 2017).

Is your agency performing above or below the national average? Download the full 2018 ESO EMS Index: Mid-Year Update today and see where you stand.

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