COVID, Overdose, Ketamine Findings Highlight 2021 ESO EMS Index

For the fourth year running, EMS data/software company ESO has released its annual comprehensive analysis of how 2,000-plus U.S. EMS agencies have performed in key areas of interest to researchers. Its 2021 ESO EMS Index analyzed information from 8.8 million 9-1-1 calls during the pandemic year of 2020, with the goal of helping EMS agencies compare their performance to their peers. The Index also provides best-practice recommendations around the six metrics it measured to help agencies improve.

Here is an overview of this year’s findings.

Stroke Assessments Up

About 140,000 Americans die from strokes each year, according to the CDC. Someone in the U.S. has a stroke every 40 seconds.

Given this, ESO wanted to know how many calls occurred during 2020 where the EMS responder believed stroke was a factor, and how often EMS conducted formal stress scale assessments in these cases. Based on the data, there were 130,221 calls where EMS providers’ impressions included stroke. “Of those encounters, 92,740 had a stroke assessment documented—or 71%,” the Index reported. “Stroke encounters were 1.5% of all 9-1-1 calls.”

Compared to previous years, “I think we’ve seen an increase in stroke scale compliance,” says Brent Myers, MD, ESO’s chief medical officer. “This is incredibly important for two reasons: First, having formal stroke data available allows EMS to route stroke victims to the most appropriate treatment centers. Second, it allows us to evaluate the usefulness of the various stroke assessment scales being used.”

Ketamine and Patient Weight (New This Year)

Ketamine is an effective sedative and analgesic, but its dosage depends on the patient’s weight. ESO wanted to know what percentage of EMS records contained estimated patient weights when ketamine was administered.

The answer: In 2020, “83% of patients (15,670 out of 18,939 calls) administered ketamine had weight recorded,” the Index found.

The relevance: “The evidence for which is the best sedative or when you should use that sedative is still being sorted out, whether it’s a benzodiazepine or a ketamine or an antipsychotic or some combination,” Myers says. “But what we know is that if you’re going to use ketamine, then you should go through the process of estimating a weight so we’re giving the best dosing we can.”

Overdose Calls Up 9.4%

EMS clinicians often encounter patients experiencing overdose, and 2020 was no exception. “Encounters involving patients with suspected overdose accounted for 2.68% of 9-1-1 calls in 2020, which is slightly higher than 2019 at 2.45%,” the Index said. This was a jump of 9.4%. Moreover, “Of these encounters for overdose, opioids were suspected in 183,188, or 77%.”

“Monitoring trends in opioid overdose has been an important priority for public health, and EMS data can really add to that conversation,” says Remle Crowe, PhD, ESO’s senior manager of clinical and operational research. “What we saw in 2020 was an increase in the proportion of EMS records for opioid overdose. This data doesn’t tell us the reason for that increase, but there have been a lot of peer-reviewed articles that suggest the stress of the pandemic and limited access to treatment options may be influencing the numbers we’re seeing.”

Use of Lights and Siren

Maybe it was due to COVID-19. Maybe it was something else. Whatever the case, this was up. “Given the ability of EMS professionals to provide stabilization for critically ill and injured patients and the known risks of lights-and-siren transportation, we were surprised to see an increase in lights-and-sirens transport of 4% compared to the prior year,” said the Index. “There were 5,181,628 patient transports included in the analysis for this metric. There were 4,297,124 documented patient transports that did not use lights and sirens, or 83% of transports.”

“We know there are risks associated with using the lights and siren, even though that’s kind of what characterizes EMS in action,” says Crowe. “We know sirens and lights during transport can cause traffic crashes and all kinds of things, so EMS professionals should be using them judiciously.”

Nontransports to Hospital (New This Year)

“COVID-19 has had a significant impact on EMS agencies and personnel in a variety of ways,” the Index understatedly noted. “One particular area that stood out in 2020 was the increased rate of nontransport dispositions, especially in the early days of the pandemic (March and April). Fear of the unknown about COVID-19 drove many people to isolate and outright avoid medical treatment of any sort—even refusing emergency department visits for some serious conditions.”

The numbers tell the tale: In 2020 “there were 1,506,784 no-transports out of 6,688,683 9-1-1 calls where EMS disposition was recorded (transfer of care to other EMS units excluded),” the Index continued. “Stated differently, 22% of all 9-1-1 calls resulted in nontransport by EMS.”

“Colloquially we call this patient refusal,” says Crowe. “But in this case we just call it nontransport because we don’t know the actual rationale for why the patient was not transported.”

COVID-19 and Flulike Impressions (New This Year)

With 2020 being the year of the pandemic, ESO examined what percentage of EMS patients appeared to be afflicted with COVID-19 or other flulike symptoms. The results: “COVID-19 and flulike primary impressions accounted for 3.8% of all encounters, with the majority coming in March and April, and a resurgence in December,” said the Index. Out of 339,378 encounters involving COVID-19/flulike symptoms during 2020, the most (70,995) occurred in December 2020, and the fewest (24,018) in September.

“At ESO one of the things we’ve been doing internally for several years is to compare influenzalike illness rates as determined by the EMS impression versus influenzalike rates that come from the CDC from their national surveillance,” Myers says. “What we found is that the EMS impressions tie very closely—and in many cases precede by several days and up to a week—the CDC reporting of influenza increases. We are hopeful such EMS data can be used to help communities determine when to ‘flip the switch’ for flu.”

To read the complete 2021 ESO EMS Index, go to www.eso.com/resources/ems-index.

James Careless is a freelance writer and frequent contributor to EMS World.