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Care Quality from EMS & 911 Left Wanting, Rural Disparities Emerge

Data showed lapses in care quality across all EMS responses and 911 calls, but there were rural/urban disparities at play, too.

The quality of care you get when you call 911 might depend on where you live, with a new analysis of emergency medical service (EMS) systems showing geographic health disparities in clinical quality.

The study from the Icahn School of Medicine at Mount Sinai was published in the journal Prehospital Emergency Care and showed some rural/urban differences in the care delivered by EMS systems.

Using data about all 911 responses in the United States in 2019, the researchers were able to analyze more than 26 million responses from just under 10,000 different EMS agencies.

The team assessed responses for certain clinical quality measures outlined by the National EMS Quality Alliance, including treatment of low blood sugar, seizures, stroke, pain, and trauma, as well as medication safety and transport safety.

There were some lapses and inconsistencies with the National EMS Quality Alliance benchmarks, the team found.

For example, pain for trauma patients improved in only 16 percent of cases after EMS treatment. Meanwhile, nearly four in 10 (39 percent) of children with wheezing or asthma attacks did not receive breathing treatments from EMS. Breathing treatments have been shown to relieve symptoms, the researchers clarified.

Finally, nearly a third of the patients with suspected stroke did not have a stroke assessment documented by EMS. Stroke assessment and early intervention are mission-critical for stroke patients who need time-sensitive treatment.

As noted above, the researchers did observe some geographic health disparities in EMS quality. For example, EMS agencies that mostly responded to calls in rural areas were less likely to treat low blood sugar or improve pain for trauma patients.

Rural EMS responses were also more likely to use lights and sirens unnecessarily compared to urban and suburban responses. The use of lights and sirens has been linked to accidents, injury, and death.

Looking at these clinical quality measures was important to the researchers, according to Michael Redlener, MD, an associate professor of Emergency Medicine at Mount Sinai and the study’s lead author. Typically, EMS systems assess quality by looking at operational measures, like response times.

“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,” Redlener said in a public statement.

“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,” he added. “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.” 

In fact, exploring clinical quality measures and not just operational measures will be key to improving overall EMS care, Redlener indicated. It will equip industry leaders with the data necessary to make patient safety improvements.

“This work is not about blaming bad EMS services, but about uncovering opportunities to improve patient care,” Redlener explained. “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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