Measuring Quality in Emergency Medical Services: A Review of Clinical Performance Indicators
Table 2
Comparison of EMS clinical performance indicators.
US clinical performance indicators*
Clinical condition
ST Elevation Myocardial infarction (STEMI)
Pulmonary Edema
Asthma
Seizure
Trauma
Cardiac arrest
Indicators or bundle elements
(1) Aspirin (2) 12 lead Electrocardio-graph (ECG) (3) Direct transport to percutaneous cardiac intervention (PCI) interval from ECG to balloon <90 minutes
(1) Blood Sugar measurement (2) Administration of a benzodiazepine
(1) Entrapment time <10 minutes (2) Direct transport to trauma for patients meeting criteria
(1) Response interval <5 min for basic CPR and Automated external defibrillators (AEDs)
Outcome
NNT = 15 Harm avoided: A stroke, 2nd myocardial infarction, or death
NNT = 6 Harm avoided: need for an endotracheal intubation
Not Specified
NNT = 4 Harm avoided: persistent seizure activity
NNT = 3 or 11 depending on criteria used Harm avoided: one death
NNT = 8 Harm avoided: one death
UK clinical performance indicators#
Clinical condition
STEMI
Stroke/TIA
Asthma
Hypoglycemia
Trauma
Cardiac arrest
Indicators or bundle elements
(1) Aspirin (2) Nitroglycerin (3) Recording pain score (before and after treatment) (4) Pain medication (5) Transfer targets for thrombolysis/PCI
(1) Recording of Face Arm Speech Test (FAST) (2) Recording of blood sugar (3) Recording of blood pressure
(1) Recording of respiratory rate (2) Recording of Peak Expiratory Flow Rate (PEFR) (3) Recording of SpO2 (4) agonist (5) Oxygen
(1) Recording of blood glucose before treatment (2) Recording of blood glucose after treatment (3) Recording treatment (4) Direct referral to appropriate health professional
Pilot indicators available only for patients with severe trauma (Glasgow Coma Score, GCS < 8) (1) Recording of blood pressure (2) Recording of respiratory rate (3) Recording of SpO2 (4) Recording of pupil reaction
(1) Return of Spontaneous circulation (ROSC) on arrival to hospital (2) Presence of defibrillator on scene (3) ALS provider in attendance (4) Call to scene response ≤4 min
Outcome
Improved assessment and management of STEMI with increased survival
Improved assessment and management of stroke
Improved assessment and management of asthma
Improved assessment and management of hypoglycemia
Not specified
Improved response to and survival from cardiac arrest