Emergency Medical Services Outcomes Evaluation Title Graphic

Executive Summary

Approach

The provision of prehospital care has come under increased scrutiny in recent years. Although it is acknowledged that timely transport is necessary for some patients, many have questioned the value of the range of prehospital care services currently provided. In the broader health care community, there is a persistent concern about the lack of proof of effectiveness related to most prehospital care. Most experts on both sides of the argument agree that methodologically sound outcomes research that identifies "what works" in prehospital care is long overdue. Clinical effectiveness studies to address EMS outcomes research require the development of sophisticated case-severity and effectiveness measures. Outcomes research will allow future generations of Americans to have an EMS system that provides both quality and cost-effective prehospital care.

Objectives

The primary goal of this work is to support and facilitate EMS outcomes research and evaluation to be conducted by the broad EMS community. In essence, a "blueprint" and a set of "tools" were developed that EMS practitioners can use to evaluate the effectiveness of prehospital care. The following objectives were met: 1) Identify conditions that should take precedence in EMS outcomes research; 2) Determine the appropriate risk adjustment measures for the priority conditions identified; 3) Determine the appropriate outcome measures for the priority conditions identified; 4) Identify important stakeholders and constituencies; 5) Develop a research dissemination plan.

Results

Seven conditions were identified for children and adults that should take precedence in EMS outcomes research. For adults, these conditions are minor trauma, respiratory distress, chest pain, major trauma, cardiac arrest, airway obstruction, and respiratory arrest. For children, these conditions are minor trauma, major trauma, respiratory distress, airway obstruction, respiratory arrest, cardiac arrest and seizures. Next, core risk adjustment measures were identified that should be considered for all conditions. These include patient age, sex, race and ethnicity, vital signs, level of responsiveness, Glasgow Coma Scale (GCS), time intervals, and the EMS provider impression. Pain, using an adjective response scale (ARS) and a numeric response scale (NRS), should be measured for all patients. Condition-specific risk adjustment measures were identified for certain conditions. Outcome measures that should be considered for all conditions include survival, cost-effectiveness, and satisfaction. However, no measures that could be used as core measures for satisfaction or cost were identified. Outcome measures pertaining to disease progression, discomfort and dysfunction may also be condition-specific. Risk adjustment measures may also function as outcome measures depending upon the point in time during the episode of care the measure is applied. The following table provides an example using three conditions.

Adult Priority Condition Risk Adjusters Outcome Measures
Minor trauma Revised Trauma Score, Glasgow Coma Scale (GCS); Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), New ISS (NISS) See risk adjusters 
SF-36
Respiratory distress Peak Expiratory Flow Rate (PEFR), Pulse Oximetry; Visual Analog Scale for Dyspnea (discomfort) See risk adjusters 
Mortality
Major trauma Revised Trauma Score, GCS, AIS, ISS, NISS See risk adjusters, SF-36, FCI, Mortality, Probability of Survival (Ps), Preventable Death Rate (PDR)

Conclusion

Priority conditions have been identified on which EMS outcomes research should be focused. Risk adjusters and outcome measures have been identified that investigators can use as tools in EMS outcomes research. These should be evaluated in the prehospital setting. A particular focus of future research should be the identification, development and evaluation of satisfaction and cost outcome measures. Past and ongoing dissemination have included presentations and publications in peer-reviewed journals. Through all of these efforts, the ultimate goal is to conduct EMS outcomes research that will improve the delivery of prehospital care, and will thus benefit the general public.

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