Home Medizin Die Studie deckt Lücken in der Leistung der Rettungsdienste auf und deutet auf Verbesserungspotenzial hin

Die Studie deckt Lücken in der Leistung der Rettungsdienste auf und deutet auf Verbesserungspotenzial hin

von NFI Redaktion

A recent study published in the journal Prehospital Emergency Care evaluates current approaches to measuring the performance of Emergency Medical Services (EMS) in the United States and identifies new strategies that can improve the quality of care provided by EMS.

Study: A national assessment of EMS performance at response and agency levels. Image source: BlurAZ / Shutterstock.com

Study: A national assessment of EMS performance at response and agency levels. Image source: BlurAZ / Shutterstock.com

Development of EMS Care Guidelines

Across the United States, a wide range of quality measures are used to assess the care provided by EMS. However, compared to hospital or outpatient medicine, there is still a lack of specific, nationally recognized, and evidence-based protocols for monitoring EMS and determining how these services can be improved.

A previous statement from the Consortium of EMS Medical Directors of Major U.S. Cities in 2007 proposed the implementation of several quality control measures for the treatment of ST-elevated myocardial infarction (STEMI), seizures, pulmonary edema, cardiac arrest, and trauma. These quality control measures guided the appropriate treatment of these conditions before arrival at the hospital and the selection of the appropriate hospital site.

In 2015, the EMS Compass initiative published a set of quality measures developed jointly 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) expanded the group of stakeholders for this initiative, ultimately leading to the development of an evidence-based set of EMS quality measures that can be broadly applied to the currently operational EMS in the United States.

These NEMSQA guidelines, published in 2019, encompass 11 quality measures covering eight areas of clinical management required in EMS.

The current study uses national EMS data to assess the implementation of these measures to evaluate the quality of EMS responses at the individual and agency levels. The dataset included 26.5 million responses conducted by nearly 10,000 EMS agencies.

Importantly, the current study is the first to determine how EMS agencies have met nationally applied quality measures.

What Did the Study Find?

Performance varied depending on agency type, size, and response category. Only 12% of EMS personnel did not use lights and sirens, compared to over 53% during patient transport. Over 80% of cases of pediatric dyspnea diagnosed by EMS were examined and documented.

Approximately 60% of trauma patients were assessed for pain, with only 16% reporting pain relief during the response process. Over 25% of patients with status epilepticus received benzodiazepines, the preferred agent, during the EMS response.

Performance measurements at the agency level also varied significantly. For pediatric cases, the agency’s performance was rated high at over 90%, while the safety assessment for these cases was at 2%.

There were 22 agencies that had over 100,000 patient calls, making up every seventh EMS call during the entire study period. The agency’s size also influenced performance, with hypoglycemia performance at 60% for the smallest agencies compared to almost 85% for larger agencies with 25,000 to 100,000 runs.

There were no significant differences between urban and rural authorities in the response to pediatric emergencies for six measures, including safety and trauma. However, differences in the performance of rural agencies were observed, though these observations may not reflect clinical outcomes.

What are the Implications?

The quality of emergency medical service delivery can vary significantly in terms of clinical and safety-related outcomes. Importantly, there is no official standard by which performance in this area can be classified as good or poor; however, the study found that over 50% of agencies scored below 35% in three of the six evaluated measures. In contrast, some agencies achieved nearly 100% performance.

„These results provide a basis for measuring overall performance and tracking the progress of the national picture,“.

While achieving 100% performance in all measures may not be ideal, the study results form the basis for further research to establish benchmarks in these areas. Additionally, the study results can be reevaluated by comparing performance indicators based on results with the process, thereby supporting the development of an evolving standardized set of measures that improves EMS delivery.

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