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) Nitroglycerin; (2) Noninvasive positive pressure ventilation	(1) 𝛽2 agonist administration	(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) 𝛽2 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

*Source: [20].
^#Source: [21].