Emergency Medical Services Outcomes Project I (EMSOP I): Prioritizing Conditions for Outcomes Research☆,☆☆,★,★★
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.
Condition Frequency (%) Weighted Score SD Index Score Minor trauma 51.3 9.6 4.52 34.3 Major trauma 7.9 17.1 4.79 25.7 Respiratory distress 10.0 15.0 5.00 24.4 Airway obstruction 1.1 17.9 4.58 22.6 Respiratory arrest .4 16.3 5.02 20.6 Cardiac arrest .8 14.4 4.88 19.1 Seizure 14.1 9.0 3.49 19.0 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.
References (34)
Quantifying the scanty science of prehospital emergency care
Ann Emerg Med
(1997)- et al.
Emergency medical services systems research: Problems of the past, challenges of the future
Ann Emerg Med
(1995) - et al.
EMS agenda for the future: where we are ... where we want to be
Ann Emerg Med
(1998) - et al.
Role of the emergency medical services system in region-wide health monitoring and referral
Ann Emerg Med
(1993) - et al.
Multiple options and unique pathways: A new direction for EMS?
Ann Emerg Med
(1997) - et al.
Developing a foundation for the evaluation of expanded-scope EMS: A window of opportunity that cannot be ignored
Ann Emerg Med
(1997) Outcome analysis in EMS systems
Ann Emerg Med
(1993)- et al.
Cost-effectiveness analysis of paramedic emergency medical services in the treatment of prehospital cardiopulmonary arrest
Ann Emerg Med
(1990) Quo vadis: “Scoop and run”, “stay and play”, or “treat and street”?
Acad Emerg Med
(1995)Unscheduled access to health care: Reengineering the 911 system
Acad Emerg Med
(1996)
Is advanced life support appropriate for victims of motor vehicle accidents: The South Carolina highway trauma project
J Trauma
Prehospital stabilization of critically injured patients: A failed concept
J Trauma
Follow-up to Review of Medical Necessity for Ambulance Services.
Ambulance Services for Medicare End-stage Renal Disease Beneficiaries: Medical Necessity.
Emergency Medical Services: Agenda for the Future (DOT HS 808 441)
Senate Joint Memorial #44: Expanded EMS Study
Medical treatment effectiveness research: A view from inside the Agency for Health Care Policy and Research
Eval Health Prof
Cited by (142)
Identifying quality indicators for prehospital emergency care services in the low to middle income setting: The South African perspective
2019, African Journal of Emergency MedicineManagement of anaphylaxis in emergency medicine. French Society of Emergency Medicine (SFMU) Guidelines with the Contribution of French Allergology Society (SFA) and the French Speaking Group in Pediatric Intensive Care and Emergency (GFRUP), and the support of the French Pediatric Pneumology and Allergology Society (SP2A)
2017, Revue Francaise d'AllergologieQuality Indicators for Evaluating Prehospital Emergency Care: A Scoping Review
2018, Prehospital and Disaster Medicine
- ☆
Supported by US Department of Transportation, National Highway Traffic Safety Administration (contract no. DTNH22-96-H-05245).
- ☆☆
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].
- ★
0196-0644/99/$8.00 + 0
- ★★
47/1/96806