Emergency Medical Services Outcomes Project I (EMSOP I): Prioritizing Conditions for Outcomes Research,☆☆,,★★

Presented in part at the Society for Academic Emergency Medicine Annual Meeting, Washington DC, May 1997, and the National Association of EMS Physicians, Mid-Year Meeting, Lake Tahoe, NV, July 1997.
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Abstract

Over the past several years, out-of-hospital EMS have come under increased scrutiny regarding the value of the range of EMS as currently provided. We used frequency data and expert opinion to rank-order EMS conditions for children and adults based on their potential value for the study of effectiveness of EMS care. Relief of discomfort was the outcome parameter EMS professionals identified as having the most potential impact for the majority of children and adults in the top quartile conditions. Future work from this project will identify appropriate severity and outcome measures that can be used to study these priority conditions. The results from the first year of this project will assist those interested in EMS outcomes research to focus their efforts. Furthermore, the results suggest that nonmortality out-come measures, such as relief of discomfort, may be important parameters in determining EMS effectiveness. [Maio RF, Garrison HG, Spaite DW, Desmond JS, Gregor MA, Cayten CG, Chew JL Jr, Hill EM, Joyce SM, MacKenzie EJ, Miller DR, O’Malley PJ, Stiell IG: Emergency Medical Services Outcomes Project I (EMSOP I): Prioritizing conditions for outcomes research. Ann Emerg Med April 1999;33:423-432.]

Section snippets

INTRODUCTION

Over the past several years, provision of out-of-hospital EMS has come under increased scrutiny. Although it is generally acknowledged that safe, timely transport is needed for many individuals experiencing an acute medical problem, experts have questioned the value of the range of out-of-hospital care services currently provided.1, 2, 3, 4, 5, 6 Furthermore, Medicare and Medicaid are refusing to pay for certain EMS interventions that were heretofore unquestioned.7, 8 Although some physicians

MATERIALS AND METHODS

The first objective was addressed in 4 phases. During phase 1, a list of EMS conditions was developed. In phase 2, frequency data were obtained for all the conditions identified. In phase 3, the relevance of various outcomes and the potential impact of EMS on these outcomes, for each condition, was determined. In phase 4, a summary index score was developed and the conditions ranked according to this index score.

RESULTS

Thirty-seven individuals (88%) returned questionnaires (21 physicians and 16 nonphysicians). Tables 3 and 4 depict the conditions ranked by the summary index score for children and adults, respectively.

. Ranking for conditions—children.

ConditionFrequency (%)Weighted ScoreSDIndex Score
Minor trauma51.39.64.5234.3
Major trauma7.917.14.7925.7
Respiratory distress10.015.05.0024.4
Airway obstruction1.117.94.5822.6
Respiratory arrest.416.35.0220.6
Cardiac arrest.814.44.8819.1
Seizure14.19.03.4919.0
Shock<.1

DISCUSSION

Using empirical data combined with expert opinion, the investigators identified conditions that should take precedence in EMS outcomes research. For adults, the top quartile conditions account for 65% of adult emergency transports and for children, 85% of emergency transports. Making these conditions EMS research priorities will focus scarce resources on conditions that not only affect a substantial portion of EMS patients, but which also have the potential of providing the greatest benefit.

Acknowledgements

We gratefully acknowledge the guidance and assistance of Joan S Harris, NHTSA, and Elizabeth Nelson Gable and Douglas E Brown, EMS Data Systems, in the completion of this work.

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    Supported by US Department of Transportation, National Highway Traffic Safety Administration (contract no. DTNH22-96-H-05245).

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    Address for reprints: Ronald F Maio, DO, MS, University of Michigan Medical Center, TC-B 1380/0305, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0305; 734-763-8949, fax 734-763-9298;E-mail [email protected].

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