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ESO Releases 2021 EMS Index


ESO, a leading data and software company serving emergency medical services (EMS), fire departments, hospitals, and state EMS/trauma offices, has announced the findings of its 2021 ESO EMS Index. The Index tracks performance of more than 2,000 EMS agencies nationwide across four metrics: stroke assessment, ketamine administration with patient weight recorded, lights and siren use, and nontransport of patients by EMS following a 9-1-1 call. Ketamine administration with patient weight recorded and nontransport disposition are new metrics added for the 2021 Index.

Apart from performance measures, the 2021 Index includes two key surveillance measures. The Index continues to look at patients with suspected overdose, since calls related to overdose continue to climb significantly. Additionally, the Index combines COVID-19 and influenzalike impressions, as differentiation in the out-of-hospital setting is difficult.

“This is the fourth year of our annual EMS Index, and we are seeing how the use of data is having a positive impact for our customers and the communities they serve,” said Dr. Brent Myers, chief medical officer for ESO. “In many ways 2020 was a unique year due to COVID-19 and mainstream conversations around the use of ketamine. We’ve adjusted some of the metrics in the Index to be timely and relevant to current trends, concerns, and conversations.”

Key findings include: 

  • Stroke assessment performance—When looking at the documented stroke assessment completion rate, we continue to see steady performance from 2019 to 2020 as 71% of patients with suspected stroke had a documented assessment. The Cincinnati Prehospital Stroke Scale (CPSS) was most commonly used.  
  • Ketamine administration with patient weight recorded—Recording patient weight is key to monitoring appropriate dosing. In 83% of cases patients administered ketamine had their weight recorded in the EMS record. 
  • Lights and siren use—EMS use of lights and siren must be judicious, as studies show use of these emergency signals increases risk of ambulance crashes. Overall, most patients were transported without lights and siren (83%).   
  • Nontransport dispositions—During COVID-19, anecdotal reports described patient hesitancy to be transported to a medical facility. Overall nontransport dispositions represented 22% of all 9-1-1 encounters. 
  • Percent of encounters for suspected overdose—Encounters involving patients who experienced suspected overdose accounted for 2.7% of 9-1-1 calls in 2020, which is 9% higher than the 2.45% observed in 2019.  
  • COVID-19 and flulike impressions—COVID-19 and flulike primary impressions accounted for 3.8% of all EMS encounters in 2020, with the majority occurring in March and April, and a resurgence in December. 

“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 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 2021 ESO EMS Index can be downloaded here.

The dataset from the ESO Data Collaborative used for the ESO EMS Index is real-world, deidentified 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 8.8 million anonymized 9-1-1 encounters between January 1, 2020 and December 31, 2020, representing a full calendar year. 

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, and state EMS 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, Tex. For more information, visit


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