Emergency Medicine International / 2012 / Article / Tab 2

Review Article

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 conditionST Elevation Myocardial infarction (STEMI)Pulmonary EdemaAsthmaSeizureTraumaCardiac 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) 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)

OutcomeNNT = 15
Harm avoided: A stroke, 2nd myocardial infarction, or death
NNT = 6
Harm avoided: need for an endotracheal intubation
Not SpecifiedNNT = 4
Harm avoided: persistent seizure activity
NNT = 3 or 11 depending on criteria used Harm avoided: one deathNNT = 8
Harm avoided: one death

UK clinical performance indicators#
Clinical conditionSTEMIStroke/TIAAsthmaHypoglycemiaTraumaCardiac 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

OutcomeImproved assessment and management of STEMI with increased survivalImproved assessment and management of strokeImproved assessment and management of asthmaImproved assessment and management of hypoglycemiaNot specifiedImproved response to and survival from cardiac arrest

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

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