Need to call 911? Good luck getting quality care

EMS care varies greatly ©Galina Barskaya - stock.adobe.com

A comprehensive study conducted by the Icahn School of Medicine of Mount Sinai sheds light on the inconsistencies in emergency medical service (EMS) care across the United States, particularly concerning adherence to national standards of quality. Published in the February 13 issue of Prehospital Emergency Care, the research highlights significant variations in EMS performance, impacting patient outcomes and safety.

Lead author, Dr. Michael Redlener, associate professor of emergency medicine at Icahn Mount Sinai, examined the inadequacy of traditional operational measures, such as response times, in assessing EMS performance comprehensively. While swift responses are crucial in critical situations, the study underscores the importance of condition-specific clinical care during medical emergencies.

Analyzing data from over 26 million 911 responses in 2019, involving 9,679 EMS agencies, the research focused on specific quality measures outlined by the National EMS Quality Alliance. The findings revealed considerable gaps in patient care across various measures. Notably, only 16% of trauma patients experienced improved pain after treatment by EMS, while a significant portion of children with wheezing or asthma attacks did not receive necessary breathing treatments.

Moreover, nearly one-third of patients with suspected strokes did not undergo a stroke assessment, potentially delaying crucial treatment. Disparities were also observed between EMS agencies primarily serving rural versus urban and suburban areas. Rural agencies exhibited lower rates of treating low blood sugar and improving trauma pain, along with a higher tendency to use lights and sirens unnecessarily during transport, despite associated risks of accidents and injuries.

Redlener said that the study aims not to cast blame but to identify avenues for enhancing patient care. The absence of national benchmarks for acceptable practice underscores the need for concerted efforts to address disparities and improve overall EMS performance.

The study recommends localized attention and quality improvement initiatives tailored to address specific performance gaps. It advocates for the establishment of clear protocols, particularly regarding the use of lights and sirens, to mitigate unnecessary risks during transport. Moreover, the research underscores the importance of including rural agencies in improvement efforts to address long-standing disparities in care.

The findings serve as a catalyst for ongoing quality improvement conversations within EMS agencies, empowering them to identify areas for enhancement and share best practices. Additionally, the study provides a basis for unified national quality improvement and research efforts, facilitating the integration of EMS quality measures into broader healthcare systems for improved patient outcomes, according to researchers.

Study authors say the study lays the groundwork for future research to evaluate EMS quality measures against outcome-based assessments, fostering a more comprehensive understanding of prehospital care and its impact on patient health and safety.