Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York.
Care2U, New York City, New York.
Prehosp Emerg Care. 2024;28(5):719-726. doi: 10.1080/10903127.2023.2283886. Epub 2024 Feb 12.
In 2019, the National EMS Quality Alliance (NEMSQA) established a suite of 11 evidence-based EMS quality measures, yet little is known regarding EMS performance on a national level. Our objective was to describe EMS performance at a response and agency level using the National EMS Information System (NEMSIS) dataset.
The 2019 NEMSIS research dataset of all EMS 9-1-1 responses in the United States was utilized to calculate 10 of 11 NEMSQA quality measures. Measure criteria and pseudocode was implemented to calculate the proportion meeting measure criteria and 95% confidence intervals across all encounters and for each anonymized agency. We omitted Pediatrics-03b because the NEMSIS national dataset does not report patient weight. Agency level analysis was subsequently stratified by call volume and urbanicity.
Records from 9,679 agencies responding to 26,502,968 9-1-1 events were analyzed. Run-level average (encounter documented as initial response without the use of lights and siren to 82% for Pediatrics-02 (documented respiratory assessment in pediatric patients with respiratory distress) At the agency level, significant variation in measure performance existed by agency size and by urbanicity. At the individual agency performance analysis, Trauma-04 (trauma patients transported to trauma center) had the lowest agency-level performance with 47% of agencies reporting 0% of eligible runs with documented transport to a trauma center.
There is a wide range of performance in key EMS quality measures across the United States that demonstrate a need to identify strategies to improve quality and equity of care in the prehospital environment, system performance and data collection.
2019 年，国家紧急医疗服务质量联盟（NEMSQA）制定了一套 11 项基于证据的紧急医疗服务质量指标，但对于国家一级的紧急医疗服务绩效却知之甚少。我们的目的是利用国家紧急医疗服务信息系统（NEMSIS）数据集，描述反应和机构层面的紧急医疗服务绩效。
本研究使用了美国所有 9-1-1 紧急医疗服务响应的 2019 年 NEMSIS 研究数据集，计算了 11 项 NEMSQA 质量指标中的 10 项。通过实施衡量标准和伪代码，计算了所有遭遇事件和每个匿名机构符合衡量标准的比例和 95%置信区间。我们省略了 Pediatrics-03b，因为 NEMSIS 国家数据集不报告患者体重。随后，根据呼叫量和城市规模对机构层面的分析进行分层。
对来自 9679 个机构的 26502968 次 9-1-1 事件的记录进行了分析。运行级别平均（记录为初始响应，不使用灯光和警笛）为 82%，适用于 Pediatrics-02（有呼吸窘迫的儿科患者的呼吸评估）。在机构层面，机构规模和城市规模的不同导致衡量标准的表现存在显著差异。在个别机构绩效分析中，Trauma-04（创伤患者转运至创伤中心）的机构绩效最低，有 47%的机构报告 0%符合条件的转运至创伤中心的运行。
美国在关键紧急医疗服务质量指标方面存在广泛的表现差异，这表明需要确定策略，以改善院前环境、系统绩效和数据收集方面的质量和公平性。
