A New Model for Measuring and Benchmarking EMS Performance

When measuring the performance of an EMS system, it’s not enough to say you got there first.
 
The survival of a patient doesn’t depend on how quickly an ALS unit arrives at the scene of an emergency call. What does matter is how quickly basic chest compressions or defibrillation attempts are started.
 
The same goes for the resuscitation rates of victims of cardiac arrest. Typically, resuscitation rates are used as a primary measure of performance for most EMS systems. Yet these calls only represent 1 percent to 2 percent of all EMS responses, which means most systems don’t know how well they’re handling the other 98 percent of their calls.
 
And while response-time intervals for advanced life support units and resuscitation rates for victims of cardiac arrest are the primary measures of EMS system performance today, exactly what these terms mean remains unclear. How long is a “response interval?” Does time being measured start when a call comes into dispatch, when a unit arrives at the location, or when treatment of the patient begins? And if cardiac arrest survival is to the point of hospital admission, should a system claim success if a patient doesn’t survive beyond the emergency room? Without standard definitions, the value of any measurement data is questionable.
 
Clearly, a new model for measuring and benchmarking EMS performance – one based on scientific evidence with uniform definitions and reporting standards – is needed.
 
The 2007 U.S. Metropolitan Municipalities’ EMS Medical Directors’ Consortium has developed such a model for large suburban and urban EMS systems. The model is based on recent data and the research behind it has been presented in an article entitled “Evidence-Based Performance Measures For Emergency Medical Services Systems: A Model for Expanded EMS Benchmarking.” The article is a statement developed by the 2007 Consortium U.S. Metropolitan Municipalities’ EMS Medical Directors, published December 12, 2007, from the section of EMF Homeland Security & Disaster Medicine, The University of Texas Southwestern Medical Center, Dallas.
 
The article proposes that the measurement of EMS system performance extend beyond the traditional focus of benchmarking cardiac arrest survival rates and response-time intervals. The new model aims to allow EMS providers to more accurately report a meaningful measurement of their performance, to set guidelines for determining which measures are best for benchmarking, and to identify, quantify and encourage the implementation of best practices in urban and suburban EMS systems.
 
Although the article asserts that evidence-based research for pre-hospital emergency medicine is limited, results from large-scale scientific research suggest specific hands-on treatment plans for several conditions including ST-segment elevation myocardial infarction, pulmonary edema, bronchospasm, seizure, and trauma patients.
 
While there are performance measures that could be used by EMS systems for internal quality assurance, the Consortium does not consider these factors appropriate for benchmarking. The proposed model considers only those medical situations for which specific treatment plans have been scientifically documented to achieve positive results, and only those that EMS systems respond to with some frequency. The goal is for the new model to create focused efforts of performance improvement and serve as a new prototype for performance measurements and benchmarking among EMS systems.
 
Resources:
To obtain a copy of the article on performance measures written by the EMS Medical Directors’ Consortium, see http://www.informaworld.com/smpp/content~content=a791816011~db=all~jumptype=rss.
 
To learn more about the EMS Performance Measures Project, which seeks to create a set of 20 to 30 EMS system performance indicators and attributes, see http://www.nasemsd.org/Projects/PerformanceMeasures/. This project is being coordinated by the National Association of State EMS Officials (NASEMSO) in partnership with the National Association of EMS Physicians (NAEMSP), and supported by the National Highway Traffic Safety Administration (NHTSA) and the Health Resources and Services Administration (HRSA).
 

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