Notable quotes from these two articles on the same study released yesterday…

• “EMS systems in the United States have traditionally relied upon operational measures, like response times, to measure performance of the system. However, this study highlights how patient care and experience are not solely determined by how fast an ambulance can arrive at the patient’s side,”

• Over half of all EMS agencies failed to meet multiple performance measures, and only one in 10 dispatches followed the exact safety guidelines set, according to the study published Tuesday in Prehospital Emergency Care.

• The rate of injuries in EMS workers is almost 15 times higher when ambulances use lights and sirens compared to when they don’t.

• Researchers looked at how many patients who were transported using lights and sirens received interventions at the hospital, and only 4.5% of patients got this type of intervention.

• The rest received interventions from EMS workers before arriving at the hospital, so the researchers recommended more research was needed to justify the use of lights and sirens in patients who need hospital intervention.

You can view a PDF of the study here.

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Quality of Care for Patients Who Call 911 Varies Greatly Across the United States, Study Finds

Mount Sinai research could lead to more consistency and safety measures

February 14, 2024

https://www.mountsinai.org/about/newsroom/2024/quality-of-care-for-patients-who-call-911-varies-greatly-across-the-united-states-study-finds

Emergency medical service (EMS) systems are not consistently providing optimal care based on new national standards of quality to patients who call 911, according to a new study from the Icahn School of Medicine of Mount Sinai.

The study demonstrates that EMS performance on key clinical and patient safety measures varies widely across urban and rural communities. The findings, published in the February 13 issue of Prehospital Emergency Care, identify opportunities that could lead to improved care during 911 responses and improved outcomes for patients across the United States.

“EMS systems in the United States have traditionally relied upon operational measures, like response times, to measure performance of the system. However, this study highlights how patient care and experience are not solely determined by how fast an ambulance can arrive at the patient’s side,” explains lead author Michael Redlener, MD, Associate Professor of Emergency Medicine at Icahn Mount Sinai. “While fast response times are essential for rare, critical incidents—like when a patient’s heart stops beating or someone chokes—the vast majority of patients benefit from condition-specific clinical care in the early stages of a medical emergency. It is essential for EMS systems, government officials, and the public to know about the quality and safety of care that is occurring and find ways to improve it.” 

This is the first study to use specific safety and clinical quality measures to assess patient care across the entire 911 system in the United States.

The research team reviewed all 911 responses in the United States for the year 2019, more than 26 million responses from 9,679 EMS agencies. They assessed specific quality measures in each call outlined by the National EMS Quality Alliance – a nonprofit organization that was formed to develop and endorse evidence-based quality measures for EMS and healthcare partners that improve the experience and outcomes of patients and care providers. This includes the treatment of low blood sugar, seizures, stroke, pain, and trauma, as well as medication safety and transport safety. Some of the notable findings were:

• Pain for trauma patients improved in only 16 percent of cases after treatment by EMS.
• 39 percent of children with wheezing or asthma attacks did not receive breathing treatments during their EMS call, even though earlier treatment can lead to earlier relief of distressing symptoms.
• Nearly one-third of patients with suspected stroke did not have a stroke assessment documented, potentially delaying or missing time-sensitive treatment.

The researchers also analyzed performance of all EMS agencies, looking at agency size and location—urban, suburban, and rural. They discovered substantial differences in agencies that primarily responded in rural communities compared to urban and suburban areas. Agencies with responses in mostly rural areas were less likely to treat low blood sugar or improve pain for trauma patients, and more likely to use lights and sirens unnecessarily when compared to EMS systems in urban and suburban communities.

Previous studies have shown that when lights and sirens are used during EMS transport there is a higher likelihood of accidents, injury, and death, so unnecessary use may be more dangerous. Dr. Redlener says the difference between the highest- and lowest-performing agencies on these key measures is notable.

“This work is not about blaming bad EMS services, but about uncovering opportunities to improve patient care,” Dr. Redlener adds. “We have to move away from solely looking at response times and start looking at performance that directly impacts the people we are meant to treat.”

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Rural EMS Patients Face Worse Health Care—And Too Many Sirens, Study Finds

Arianna Johnson

Forbes Staff

February 13, 2024

https://www.forbes.com/sites/ariannajohnson/2024/02/13/rural-ems-patients-face-worse-health-care-and-too-many-sirens-study-finds/?sh=31bf67665bbb

Emergency medical services in rural areas are less likely to reduce pain in trauma patients provide proper care to kids with asthma attacks, and are more likely to use lights and sirens unnecessarily, according to a study published Tuesday, adding to previous research that found rural health systems struggle more compared to urban and suburban areas.

KEY FACTS

The team of researchers from the Icahn School of Medicine of Mount Sinai looked at all the 911 dispatches in the U.S. in 2019—which consisted of over 6 million responses from 9,679 EMS agencies—and graded EMS agencies based on some of the National EMS Quality Alliance’s performance measures, like effectiveness of pain management and taking trauma patients to trauma centers.

Over half of all EMS agencies failed to meet multiple performance measures, and only one in 10 dispatches followed the exact safety guidelines set, according to the study published Tuesday in Prehospital Emergency Care.

EMS agencies with responses in mostly rural areas were on average more than 25% more likely to use lights and sirens unnecessarily when responding to calls, and 5% less likely to improve trauma patients’ pain and treat low blood sugar compared to agencies in suburban and urban areas.

Almost 40% of children who suffered asthma attacks or breathing problems from all communities didn’t receive treatment from EMS, but those in rural areas received it at a rate of about 10% less, according to Tuesday’s study.

Almost a third of patients in all communities suspected of a stroke didn’t receive a stroke assessment, which the researchers believe could have delayed or completely stopped the patients from receiving timely treatment.

SURPRISING FACT

The national average from the time of a 911 call to arrival on scene is seven minutes, but that time doubles to 14 minutes in rural areas, and around one in 10 encounters take 30 minutes, according to a 2017 JAMA study.

CRUCIAL QUOTE

“While fast response times are essential for rare, critical incidents—like when a patient’s heart stops beating or someone chokes—the vast majority of patients benefit from condition-specific clinical care in the early stages of a medical emergency,” lead author Michael Redlener, an associate professor for the Icahn School of Medicine of Mount Sinai, said in a statement.

KEY BACKGROUND

Rural communities have worse or struggling medical systems because they’re often isolated from bigger cities, and they tend to have a shortage in doctors, according to the National Institutes of Health. EMS agencies in isolated areas respond to more critical, life-threatening calls that require more timely response times than suburban and urban EMS providers, mainly because rural areas are poorer, older and sicker.

Large geographic areas with scattered populations, longer travel distances and challenging weather conditions and terrain are all factors into longer dispatch times in rural communities, the federally funded Rural Health Information Hub says.

Another factor at play is the closure of hospitals in rural areas. There were 136 rural hospital closures between 2010 and 2021, with a historic 19 in 2020 alone—the most of any year in the past decade—according to a 2022 report from the American Hospital Association. Hospital closures means still-standing hospitals have an increased coverage area: rural ambulance travel times increase 76% in the year directly following a closure, a 2019 University of Kentucky study found.

TANGENT

The use of sirens and flashing lights by ambulance vehicles has been a long-debated topic within the medical community.

Lights and sirens are meant to decrease response and transport times, and research suggests they cause a “modest” reduction in EMS response time between 1.7 to 3.6 minutes, and reduce transport time between 0.7 to 3.8 minutes.

However, some argue they do more harm than good. The risk of crash more than doubles when emergency vehicles use lights and sirens while transporting a patient, according to the National Safety Council.

The rate of injuries in EMS workers is almost 15 times higher when ambulances use lights and sirens compared to when they don’t.

Researchers looked at how many patients who were transported using lights and sirens received interventions at the hospital, and only 4.5% of patients got this type of intervention.

The rest received interventions from EMS workers before arriving at the hospital, so the researchers recommended more research was needed to justify the use of lights and sirens in patients who need hospital intervention.